Introduction. Hypervirulent-K. pneumoniae (hvKP) is an evolving pathotype that is more virulent than the classical- K. pneumoniae (cKP) and causes serious fatal illnesses.

Hypothesis/Gap Statement. Although there are few reports on hvKP isolated from Egyptian patients, the molecular characteristics and clonal relatedness of MDR-hvKP have not been adequately investigated.

Aim. To investigate the microbiological and genetic characteristics as well as the epidemiology of hvKP induced ventilator-associated pneumonia (VAP).

Methodology. A retrospective study of 59 K . pneumoniae inducing VAP was conducted at Assiut University Hospitals from November 2017 to January 2019. All K. pneumoniae were tested for resistance phenotype, capsular genotype (K1 and K2), virulence gene profile (c-rmpA, p-rmpA, iucA, kfu, iroB, iroN), and the presence of resistance genes (blaNDM-1, blaCTX-M-3-like, blaCTX-M-14-like). Clonal relatedness was assessed by Pulsed field gel electrophoresis (PFGE).

Result. HvKP accounted for 89.8 % (53/59) of K. pneumoniae isolates with ~95 % exhibiting extensively-drug resistant (XDR) phenotype. Hypermucoviscous phenotype was detected in 19 (35.8 %) hvKP and K2 capsular gene was identified in 18 (33.9 %) of hvKP. Regarding the virulence genotype of hvKP strains, iucA was the most prevalent virulence gene (98.1%), while p-rmpA and kfu were detected in 75.4 and 52.8 % of hvKP strains, respectively. Resistance genes were highly prevalent in both cKP and hvKP with blaCTX-M-3-like being more prevalent in hvKP (100 % vs 94.3 % for blaNDM-1, 50 % vs 62.2 % for blaCTX-M-3- like and 83.3 % vs 69.8 % for blaCTX-M-14 -like, respectively). PFGE typing of 29 representative K. pneumoniae revealed 15 pulsotypes, with identical hvKP pulsotypes isolated from different ICUs at different times and several hvKP and cKP isolates belonged to the same pulsotype.

Conclusion. This study highlights the dominance and clonal spread of XDR-hvKP strains at Assiut University Hospital in Egypt. Physicians should be aware of the increased risk of hvKP induced-VAP and support further epidemiologic studies.

Coronary artery disease remains a significant health problem, especially in developing countries. Adherence to guideline-directed therapy improves the quality of care. In this study we assessed adherence to quality indicators (QIs) for ST-elevation myocardial infarction (STEMI) management in our center as an example from a developing country. Our study included 870 STEMI patients who were admitted to our center (Assiut University Heart Hospital, Egypt) and eligible for primary percutaneous coronary intervention during the period from January 2022 to December 2022. Fifteen QIs were studied. The results show that our center is closely adherent to STEMI management guidelines. However, the most important gaps were related to time delays. The mean of first medical contact (FMC) to electrocardiogram (ECG) time was 13.2 ± 16.1 minutes and arrival time to ECG time was 12.8 ± 3.9 minutes. The mean of FMC to device time for total patients was 61.2 ± 42.8 minutes. However, that for patients transferred from non-PCI capable center was 108.2 ± 63.5 minutes compared to patients presented directly to our center (mean arrival time to a device was around Mean 49.6 ± 22.5 minutes). This resulted in only 77% of patients having FMC to device time < 90 minutes. Regarding guideline-directed medical therapy, we are adherent by more than 90%. In-hospital mortality was 1.1%. So we conclued that many centers in developing countries are closely adherent to QIs of STEMI management. However, there are still some limitations including delays in transportation, a limited number of primary PCI centers, absence of a well-established network of communication between centers, and financial issues.

The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6–12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.

Abstract

Background and Objectives

Optimal blood pressure control is achieved by medication adherence. This will reduce the risk of associated morbidities and mortalities. The present study aimed to determine medication adherence and its associated factors among hypertensive patients attending different primary health centers (PHC) in Abha, Saudi Arabia (KSA).

Methods

A cross-sectional study was conducted among ten different PHCs in Abha, KSA. Simple random sampling procedure was utilized to choose 400 participants. A structured anonymous questionnaire was used in the present study. Analysis of the data was done using the SPSS program, version 23. A logistic regression statistical test was applied to identify the independent associated factors of medication adherence. Furthermore, we have applied Spearman’s test to find the correlation between overall B-IPQ score and medication adherence score.

Results

A total of 400 hypertensive patients responded in the present survey. More than one-third of the participants (36.3%) were in the high adherence category group, while the remaining participants (63.7%) were either low or medium adherence category. The binary logistic regression analysis revealed that low and medium adherence category is significantly associated with age (adjusted odds ratio [AOR] = 0.96, 95% CI =0.93–0.99, p = 0.021), married participants (AOR = 0.42, 95% CI =0.33–0.58, p = 0.001), residing at village (AOR = 1.49, 95% CI =1.14–1.73, p = 0.038), and participants with monthly family income of 5000 to 7000 SAR (AOR = 3.06, 95% CI =1.62–5.79, p = 0.001). A negligible positive correlation was revealed between illness perception and medication adherence.

Conclusion

The present study revealed that hypertensive patients poorly adhere to their antihypertensive medications. This low adherence is significantly associated with the age, monthly income, people living in rural areas, and married participants. The present study results recommend sustained efforts to implement health education programs and awareness-raising interventions targeted at hypertensive patients.

Introduction :This study aimed to evaluate the phonatory function of recovered COVID-19 survivors. The universal outbreak
of COVID-19 led to the occurrence of otolaryngological manifestations that raised concerns about the assessment of the
phonatory function in recovering patients.
Methods :This is a prospective, cross-sectional, case-controlled study carried out on 364 laboratory-confirmed non-critical
COVID-19 survivors and 100 as healthy controls. The study participants were classified into two groups according to the
disease severity. Group1 comprised 212 survivors who recovered from pneumonia and group 2 was made up of 152 survivors
of severe pneumonia. All patients were subjected to an auditory perceptual assessment of the voice (APA) and Maximum
Phonation Time (MPT) measurements.
Results: Phonasthenic manifestations were significantly more frequent in COVID-19 survivors than in controls (P < 0.000)
with a higher percentage recorded among severe pneumonia survivors (87.5%) than among pneumonia survivors (60.8%)
with a P value of < 0.01. Dysphonia and excessively soft loudness were significantly more common among survivors than
among controls (P < 0.002 and P < 0.000, respectively) with no significant difference between the patient groups. The MPT
was significantly shorter among survivors than among controls (P < 0.000). The mean MPT was 15.97 s in the control group,
10.72 s in the pneumonia group, and 8.88 s in the severe pneumonia group, with the differences between the groups being
statistically significant (P < 0.000), suggesting a higher impairment of lung volume and phonatory function in severe cases.
Conclusions: Phonasthenia, dysphonia, and decreased MPT could be otolaryngological manifestations of COVID-19. Laryngeal
function assessment should be considered in COVID-19 survivors.
Keywords :Phonasthenia · Dysphonia · COVID-19 survivors · MPT · Pneumonia

^{introduction: This study aimed to evaluate the phonatory function of recovered COVID-19 survivors. The universal outbreak}

^{of COVID-19 led to the occurrence of otolaryngological manifestations that raised concerns about the assessment of the}

^{phonatory function in recovering patients.}

^{Methods :This is a prospective, cross-sectional, case-controlled study carried out on 364 laboratory-confirmed non-critical}

^{COVID-19 survivors and 100 as healthy controls. The study participants were classified into two groups according to the}

^{disease severity. Group1 comprised 212 survivors who recovered from pneumonia and group 2 was made up of 152 survivors}

^{of severe pneumonia. All patients were subjected to an auditory perceptual assessment of the voice (APA) and Maximum}

^{Phonation Time (MPT) measurements.}

^{Results: Phonasthenic manifestations were significantly more frequent in COVID-19 survivors than in controls (P < 0.000)}

^{with a higher percentage recorded among severe pneumonia survivors (87.5%) than among pneumonia survivors (60.8%)}

^{with a P value of < 0.01. Dysphonia and excessively soft loudness were significantly more common among survivors than}

^{among controls (P < 0.002 and P < 0.000, respectively) with no significant difference between the patient groups. The MPT}

^{was significantly shorter among survivors than among controls (P < 0.000). The mean MPT was 15.97 s in the control group,}

^{10.72 s in the pneumonia group, and 8.88 s in the severe pneumonia group, with the differences between the groups being}

^{statistically significant (P < 0.000), suggesting a higher impairment of lung volume and phonatory function in severe cases.}

^{Conclusions :Phonasthenia, dysphonia, and decreased MPT could be otolaryngological manifestations of COVID-19. Laryngeal}

^{function assessment should be considered in COVID-19 survivors.}