Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.

T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).

PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).

PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.

Diagnosing HIV-Associated Neurocognitive Disorders (HAND) requires attributing neurocognitive impairment and functional decline at least partly to HIV-related brain effects. Depressive symptom severity, whether attributable to HIV or not, may influence self-reported functioning. We examined longitudinal relationships among objective global cognition, depressive symptom severity, and self-reported everyday functioning in people with HIV (PWH).

Longitudinal data from 894 PWH were collected at a university-based research center (2002–2016). Participants completed self-report measures of everyday functioning to assess both dependence in instrumental activities of daily living (IADL) and subjective cognitive difficulties at each visit, along with depressive symptom severity (BDI-II). Multilevel modeling examined within- and between-person predictors of self-reported everyday functioning outcomes.

Participants averaged 6 visits over 5 years. Multilevel regression showed a significant interaction between visit-specific global cognitive performance and mean depression symptom severity on likelihood of dependence in IADL (p = 0.04), such that within-person association between worse cognition and greater likelihood of IADL dependence was strongest among individuals with lower mean depressive symptom severity. In contrast, participants with higher mean depressive symptom severity had higher likelihoods of IADL dependence regardless of cognition. Multilevel modelling of subjective cognitive difficulties showed no significant interaction between global cognition and mean depressive symptom severity (p > 0.05).

The findings indicate a link between cognitive abilities and IADL dependence in PWH with low to moderate depressive symptoms. However, those with higher depressive symptoms severity report IADL dependence regardless of cognitive status. This is clinically significant because everyday functioning is measured through self-report rather than performance-based assessments.

The cardiovascular adaptations associated with structured exercise training in Fontan patients remain unknown. We hypothesised that short-term training causes cardiac remodelling and parallel improvement in maximal exercise capacity (VO2 max) in these patients.

Five patients, median age 19.5 (17.6–21.3) years, with a history of Fontan operation meeting inclusion/exclusion criteria, participated in a 3-month training programme designed to improve endurance. Magnetic resonance images for assessment of cardiac function, fibrosis, cardiac output, and liver elastography to assess stiffness were obtained at baseline and after training. Maximal exercise capacity (VO2 max) and cardiac output Qc (effective pulmonary blood flow) at rest and during exercise were measured (C2H2 rebreathing) at the same interval. VO2 max increased from median (IQR) 27.2 (26–28.7) to 29.6 (28.5–32.2) ml/min/kg (p = 0.04). There was an improvement in cardiac output (Qc) during maximal exercise testing from median (IQR) 10.3 (10.1–12.3) to 12.3 (10.9–14.9) l/min, but this change was variable (p = 0.14). Improvement in VO2 max correlated with an increase in ventricular mass (r = 0.95, p = 0.01), and improvement in Quality-of-life inventory (PedsQL) Cardiac scale scores for patient-reported symptoms (r = 0.90, p = 0.03) and cognitive problems (r = 0.89, p = 0.04). The correlation between VO2 max and Qc showed a positive trend but was not significant (r = 0.8, p = 0.08). No adverse cardiac or liver adaptations were noted.

Short-term training improved exercise capacity in this Fontan pilot without any adverse cardiac or liver adaptations. These results warrant further study in a larger population and over a longer duration of time.

NCT03263312, Unique Protocol ID: STU 122016-037; Registration Date: 18 January, 2017.

There are no conclusive findings about the possible protective role of religion on students’ mental health during the COVID-19 pandemic. Therefore, more research is needed.

The purpose of this study was to assess the relationship between the level of emotional distress and religiosity among students from 7 different countries during the COVID-19 pandemic.

Data were collected by an online cross-sectional survey that was distributed amongst Polish (N = 1196), Bengali (N = 1537), Indian (N = 483), Mexican (N = 231), Egyptian (N = 565), Philippine (N = 2062), and Pakistani (N = 506) students (N = 6642) from 12th April to 1st June 2021. The respondents were asked several questions regarding their religiosity which was measured by The Duke University Religion Index (DUREL), the emotional distress was measured by the Depression, Anxiety, and Stress Scale-21 (DASS-21).

Egypt with Islam as the dominant religion showed the greatest temple attendance (organizational religious activity: M=5.27±1.36) and spirituality (intrinsic religiosity: M=5.27±1.36), p<0.0001. On another hand, Egyptian students had the lowest emotional distress measured in all categories DASS-21 (depression: M=4.87±10.17, anxiety: M=4.78±10.13, stress: M=20.76±11.46). Two countries with the dominant Christian religion achieved the highest score for private religious activities (non-organizational religious activity; Mexico: M=3.94±0.94, Poland: M=3.63±1.20; p<0.0001) and experienced a moderate level of depressive symptoms, anxiety, and stress. Students from Mexico presented the lowest attendance to church (M=2.46±1,39) and spirituality (M=6.68± 3.41) and had the second highest level of depressive symptoms (M=19.13±13.03) and stress (M=20.27±1.98). Philippines students had the highest DASS-21 score (depression: M=22.77±12.58, anxiety: M=16.07±10.77, stress: M=4.87±10.08) and their level of religiosity reached average values in the whole group. The performed regression analysis confirmed the importance of the 3 dimensions (organizational religious activity, non-organizational religious activity, intrinsic religiosity) of religiosity for the well-being of students, except for the relationship between anxiety and private religious activities. The result was as presented for depression: R2=0.0398, F(3.664)=91.764, p<0.0001, SE of E: 12.88; anxiety: R2=0.0124, F(3.664)=27.683, p<0.0001, SE of E: 10,62; stress: R2= 0.0350, F(3.664)=80.363, p<0.0001, SE of E: 12.30.

The higher commitment to organizational religious activity, non-organizational religious activity, and intrinsic religiositywas correlated with the lower level of depressive symptoms, stress, and anxiety among students during the COVID-19 pandemic, but taking into account factors related to religiosity explains the level of emotional well-being to a small extent.

None Declared

Epilepsy is a neurologic condition characterized by spontaneous jerky body movements. It is a chronic morbid condition mostly diagnosed during childhood. Patients are maintained on long-term medications to prevent recurrent seizures that can damage the brain. Medications used for the management of epilepsy have several side effects and require proper monitoring. Patients with epilepsy are at increased risk of psychiatric comorbidities.

Our aim is to find factors responsible for causing suicidality in patients with epilepsy.

A review was conducted using Pubmed database with the search terms [epilepsy] OR [neurological conditions] OR [suicide] OR [suidical attempt] OR [suicidal ideation] OR [depression] OR [psychiatric diseases] OR [mood disorders] OR [anxiety] OR [sleeplessness] which yielded around 800 articles. The number was later reduced to be centered around the main area of interest and produced around 40 articles.

Results show that many contributing factors play an unavoidable role in promoting suicidal ideation that can lead to suicidal attempts in epilepsy. The stigma associated with epilepsy leads to social isolation, lack of opportunities, financial constraints, and impact on close relationships which can be the reasons for depression. According to the review, the foremost contributing factor is the underlying social, emotional, and economic condition of epilepsy patients. Depression and anxiety are the most prevalent psychiatric comorbidities in epileptic patients. Epileptic patients who develop psychiatric ailments show decreased adherence to medications that further worsen the problem.

Though, this area in neurology has started getting attention for further research and guidelines. But efforts are still inadequate for this to be put into clinical practice. More desperate actions needed to be taken for proper diagnosis and management of suicidal ideations by proper use of assessment tools so that timely actions are planned. This is a highly demanding area due to the impact of depressive symptoms on the prognosis of the chronic neurologic condition.

Keywords: Suicidality; Epilepsy; neurology.

None Declared

This study aimed to evaluate the quality-of-life outcomes following transmastoid plugging of semicircular canal dehiscence in a newly established service in a UK hospital.

Quality-of-life outcomes were measured using the Glasgow benefit Inventory score in three patients who underwent transmastoid plugging for superior semicircular canal dehiscence between September 2019 and March 2020. Patients also completed pre- and post-operative symptomatic questionnaires and vestibular-evoked myogenic potential testing.

All three patients reported an improvement in overall quality-of-life outcomes with a mean overall Glasgow Benefit Inventory score of +37 (range, +22.2–66.6). There were no immediate post-operative complications and hearing was preserved in all patients.

This study reported an initial successful experience with transmastoid plugging of superior semicircular canal dehiscence. In all patients, improvement in quality-of-life measures and symptoms was reported.

In spite of continuous refinements in tympanoplasty techniques, results are variable, and it is not uncommon to see a discharging eardrum even after a good graft uptake. This study aimed to evaluate the efficacy of total annulus excision tympanoplasty in comparison with conventional underlay tympanoplasty.

This was a double blinded, randomised, controlled trial performed at a tertiary care centre. After inclusion and exclusion criteria were met, 56 patients were enrolled and randomised, and 28 patients were allocated to each group (group A (conventional tympanoplasty) and group B (total annulus excision)). Patients and evaluators were blind to the procedure performed.

Patients in group B (total annulus excision) showed better graft uptake and no discharge with better gains in air conduction thresholds (p < 0.05) when compared with group A (conventional tympanoplasty).

In view of the advantages it offers, total annulus excision tympanoplasty may be preferred over the conventional techniques in patients with central perforations.

In Malaysia, national methadone maintenance therapy program was started by the goverment in October 2005 as part of harm reduction approach in reducing HIV prevalence among drug users along with needles and Syringes exchange(NSEP) program. However, slow coverage of MMT treatment occurs due to limited resources in existing health facilities and lack of participation from general practioners(Gps). There is a need for another paltform to increase coverage and participation of GPs in national MMT program.

To compare the retention rate and other outcomes measures between SEDAR program and Standard MMT treatment in hospital.

To determine the feasability of MMT program in mosque environment.

The pilot MMT program known as SEDAR program was conducted in Ar-Rahman mosque involving 30 clients. Brief spiritual intervention(BSI) was given by mosque staffs on top of standard MMT treatment counseling. BSI include washing body parts with water or “wuduk”, praying in the mosque or “tahiyatul masjid” and recite “doa” in the mosque environment prior to direct observed therapy of methadone in the mosque by the pharmacist. The retention rate, % of urine drugs negative over time period, drug use and HIV risk behavior, quality of live and spiritual progress were measure using specific tools: OTI, WHO Qol, SF36, HIR96.

We expect the SEDAR group in Mosque has better outcomes or comparable with standard MMT treatment in hospital setting.

The SEDAR program is feasable to increase coverage of MMT program in Malaysia.

Stigmatization of individuals with mental illnesses is widespread and serves as a major barrier to treatment. Specific alterations in mental health literacy about a disorder and its perceived treatability can change this social attitude. Assessing awareness of bipolar disorder is important as the WHO ranked bipolar disorder as the sixth cause of disability.

To assess mental health literacy (knowledge, attitudes and beliefs) in bipolar disorder among Saudi population.

Cross sectional study is currently conducted. We are using valid reliable questionnaire assessing the level of awareness, knowledge, attitude and behavior toward bipolar disorder. It is distributed to adult Saudi citizen (> 17 years of age) in malls, university and hospitals in Riyadh. People who are known to have psychiatric disorder and their caregivers or who works as psychiatrists and psychologists are excluded.

There are 200 samples collected, and 14 were excluded according to exclusion criteria. Fifty-two percent of our preliminary sample has heard about bipolar disorder, and more than half of them believe that neurotransmitter disturbances, substance use and psychological trauma are more likely to be causes of bipolar. In contrast, 49% of the sample did not choose psychiatric medication as effective treatment for bipolar, whereas more than half of them chose praying.

It is a first-of-its-kind research study in Saudi Arabia determining the current mental health literacy of bipolar disorder in Saudi Arabia. We are aiming to increase the sample size to reach 1000 participants. Further study will be needed to investigate possible interventions to improve such problem.

The authors have not supplied their declaration of competing interest.