Alexandria Hospital Research Articles

Association between some environmental risk factors and attention-deficit hyperactivity disorder among children in Egypt: a case-control study

BackgroundAttention-Deficit Hyperactivity Disorder (ADHD) is a complex disease that negatively impacts the social and academic/occupational activities of children and is more common in boys than in girls.MethodsThis case-control study aimed to assess the association between some environmental risk factors and ADHD among children in Alexandria, Egypt. It was carried out at the outpatient clinics of El Shatby Pediatric University Hospital in Alexandria, Egypt, with 252 children (126 cases and 126 controls). Hair samples were collected for analysis of lead and manganese levels using Atomic Absorption Spectrophotometer. A pre-designed interview questionnaire was used to determine the important environmental risk factors that may be related to ADHD.ResultsChildren from parents with low levels of education, living in crowded houses, and occupational exposure to chemical agents were found to be risk factors for ADHD. The mean ± SD hair lead level in ADHD children was 2.58 ± 1.95, while in controls was 1.87 ± 0.92, with a statistically significant difference (p < 0.001). The mean ± SD hair manganese level in ADHD children was 2.10 ± 1.54, while in controls was 1.11 ± 0.69, with a statistically significant difference (p < 0.001). The logistic regression model revealed that six factors had a significant association with ADHD: using of newspapers to wrap food 3 or more times a week (adjusted odds ratio (AOR) = 105.11, 95% CI: 11.18-988.26), daily TV watching by child for more than 5 h (AOR = 63.96, 95% CI: 2.56-1601.32), child’s eating commercially packed noodles 3 times or more per week (AOR = 57.73, 95% CI: 3.77–593.93), using unpackaged flour in cooking (AOR = 44.47, 95% CI: 1.83–629.80), eating sweets daily by child (AOR = 6.82, 95% CI: 1.23–37.94), and lastly elevated hair Manganese level (AOR = 3.57, 95% CI: 1.24–10.29).ConclusionsADHD is a multi-factorial disorder, where many environmental risk factors contribute to its development. Future efforts to determine the best preventive strategy in Egypt must be based on a better knowledge of the role of environmental risk factors in the etiology of the disorder. Eliminating non-essential uses of lead and providing public education regarding the importance of safe disposal of lead-acid batteries and computers are necessary.

Talent management in volatility, uncertainty, complexity, and ambiguity (VUCA) health environment, nurses’ psychological contract fulfillment, cordial relation and generation: moderation-mediation model

BackgroundThe VUCA in the healthcare environment requires combating volatility, uncertainty, complexity, and ambiguity through highly talented employees and implementing a talent management strategy. This encompasses a range of operations designed to find, attract, nurture, and utilize competent workers that impact how well nurses fulfill their psychological contracts. However, as the researchers had anticipated, several factors, such as cordial relationships and generation differences, may mediate or influence this correlation.MethodsFor a cross-sectional study, a non-probability convenience sampling technique was used to include n = 375 nurses from among the 600 total nurses at three private hospitals in Alexandria, Egypt. Three validated measures were used to measure the study variables and develop a mediation-moderation structural equation model.ResultsThe result of this study revealed that nurses perceived a moderate level of talent management with a mean score of (48.91 ± 18.15), a low mean score (8.89 ± 3.93) of psychological contract fulfillment, and a moderate mean score (185.11 ± 27.02) of cordial relation. Additionally, more than half of the participants were in the Gen Z. Also, this study concluded that there is a positive mediation role of cordial relation and a negative moderation role of Gen between talent management and psychological contract fulfillment.ConclusionsUsing Gen as a moderating variable and cordial relations as a mediating factor, a moderating mediating structural equation model is created and validates the important influence of talent management on nurses’ psychological fulfillment, confirming the mediating effect of cordial relations and the moderating effect of genes in this relationship. GEN negatively predicted psychological contract fulfillment, meaning baby boomers predicted more psychological contract fulfillment than Z gen. Furthermore, talent management could positively predict cordial relations and psychological contract fulfillment, and cordial relations partially mediated the relationship between talent management and psychological contract fulfillment. Nurse mangers should be aware of and implement effective and talent management strategies with respecting gen difference, and apply tailored strategies for fostering nurses’ cordial relation and psychological contract fulfillment to deal with the VUCA challenging healthcare environment.

Effect of Self-Proning on Respiratory Functions, Pneumonia Severity, and Mortality Risk Among Patients Diagnosed With Community-Acquired Pneumonia: A Nursing-Based Quasi-Experimental Study.

Assessing and monitoring respiratory parameters, such as respiratory rate, oxygen saturation, and lung sounds, is crucial for the management and prognosis of pneumonia patients. Prone positioning has been shown to improve oxygenation in patients with respiratory disorders, including pneumonia, by reducing ventilation/perfusion mismatch. However, there is a lack of evidence supporting the benefits of self-proning in spontaneously breathing pneumonia patients. This study aims to evaluate the effect of self-proning on respiratory functions, pneumonia, and mortality risk among patients diagnosed with community-acquired pneumonia. The study used a pre- and post-test quasi-experimental design with a control group, adhering to the Transparent Reporting of Evaluations with Nonrandomized Designs guidelines. It was conducted in the Medical Respiratory Department inpatient wards at the Respiratory Diseases Hospital in Alexandria, Egypt. The study recruited 128 patients with community-acquired pneumonia, conveniently assigned to an intervention group (n = 64) and a control group (n = 64). Data were collected using socio-demographic and historical data sheets, respiratory parameters assessment sheets, the confusion uremia respiratory rate and blood pressure (CURB-65) severity of pneumonia score, and the Pneumonia Severity Index. Prone positioning significantly positively impacted respiratory parameters in the intervention group compared to the control group. Specifically, the intervention group exhibited improvements in respiratory rate, oxygen saturation, reduced need for supplemental oxygen, and cough (p < .05). Furthermore, the intervention group exhibited fewer changes in findings from chest inspection, palpation, and auscultation. In addition, the severity of pneumonia was reduced in the intervention group compared to the control group, as indicated by lower CURB-65 (p = .014) and pneumonia severity index scores (p = .005). The study demonstrated that self-proning interventions significantly improved respiratory functions and reduced the risk of death among participants with community-acquired pneumonia. These findings suggest that self-proning is a beneficial technique for managing respiratory distress, particularly in non-intubated patients, and can be an effective strategy to improve patient outcomes in clinical settings.

Spring-Wire Technique as a Cost-Effective Alternative for Volar Rim Fragment Fixation in Distal Radius Fractures.

Introduction Volar rim fragment fixation is difficult to manage, as it is distal to the watershed line, rendering normal volar plates unable to securely capture it. This fragment must be precisely addressed as volar carpal subluxation is unavoidable when fixation is not efficient. The spring-wire technique maintains a stable fixation of this key fragment, which has been previously described in a small series. Materials and methods This is a prospective study of 20 patients who presented to El-Hadara University Hospital in Alexandria between the years 2020 and 2022, with complex distal radius fractures and small volar rim fragments, who were treated by open reduction and internal fixation using the spring-wire technique. The study was approved by the institutional review board of Alexandria Main University Hospital, and informed consent was taken from all patients in this study ensuring compliance with ethical standards. All patients underwent open reduction and internal fixation using the spring-wire technique. The procedure was performed by the same surgical team to ensure consistency. Postoperative radiographs were taken to assess reduction quality and fixation. Postoperative radiographic parameters, range of motion, grip strength and the El-Hadara wrist function scoring system were obtained after one year of follow-up, to evaluate results of fixation. Results All patients achieved a functional range of motion and grip strength and showed radiological union of the volar rim fragment with no volar carpal subluxation or escape of the volar rim fragment. The El-Hadara wrist function average score was 18.85±2.66, which represented a good overall result. No complications occurred during follow-up, and none of the patients required removal of the implant. Conclusion The spring-wire technique maintains a stable fixation of the volar rim fragment that cannot be held securely by volar plating alone. This method offersa low-profile implant that is readily available and simple to apply. Also, the fragment is stabilized by a dual effect by both the spring wire and the volar plate that act as a buttress to volar displacement.

The effect of organizational silence on the relationship between workplace ostracism and nurses' procrastination behavior: A structural equation modeling.

This study aims to assess the relationship between workplace ostracism and the procrastination behavior of nurses, as well as examine the effect of organizational silence on this relationship. Controlling workplace ostracism and eradicating time wasters, especially procrastination behavior among nurses, are key strategies that add value to organizational effectiveness. In addition, remaining silent about significant issues facing nurses is a devastating approach to the success of both healthcare organizations and the nursing profession. A cross-sectional descriptive correlational exploratory research design was used to conduct the study. Data were collected from 352 nurses recruited from three large university hospitals in Alexandria, Egypt. Four instruments, namely, the Workplace Ostracism Questionnaire, the Organizational Silence Scale, the Active Procrastination Scale, and the Unintentional Procrastination Scale, were used. Structural equation modeling was used to test the hypothesized relationships among the variables. The findings demonstrated a significant positive and moderate association between workplace ostracism and both active and passive procrastination behaviors among nurses. Moreover, there was a strong positive and significant correlation between organizational silence and workplace ostracism. The results of mediation revealed that the indirect effect of workplace ostracism on both active and passive procrastination behavior through organizational silence was statistically significant, suggesting that organizational silence partially mediated this relationship. The study highlighted the ongoing challenges posed by toxic workplace issues, such as organizational ostracism and silence, as significant factors contributing to nurses' procrastination behaviors. Not only do these factors directly impact nurses' productivity, but they also interact to exacerbate negative outcomes in nursing care. Addressing these toxic dynamics is critical to improving nurse performance and ensuring quality care in healthcare settings. This study offers new insights for navigating toxicity and upgrading nursing productivity in healthcare organizations through fostering a more inclusive and communicative work environment. Promoting team cohesion and ensuring that all staff members feel valued and included can reduce feelings of isolation that may lead to procrastination. Also, creating safe spaces for nurses to voice concerns without fear of reprisal could significantly diminish passive procrastination, which ultimately enhances overall patient care quality and organizational efficiency.

Prevalence, duration, and factors influencing post-COVID conditions among patients at several public hospitals, Alexandria governorate, Egypt 2022–2023

BackgroundPost-COVID conditions (PCC), characterized by persistent symptoms following acute infection, represent an emerging chronic illness that potentially affects millions of people worldwide. SARS-CoV-2 infection has resulted in a PCC incidence ranging from 10 to 30 % in non-hospitalized individuals to 50–70 % in hospitalized patients. Most PCC patients experience mild symptoms, while a minority report severe manifestations. We aimed to estimate the prevalence of PCC among COVID-19 patients who attended three public hospitals in Alexandria, Egypt between June 2022 and February 2023, and to investigate its risk factors. MethodsAll COVID-19-confirmed patients aged >18 years attended the selected hospitals, and their household contacts were contacted. Data were collected through telephone interviews using a questionnaire adapted from World Health Organization (WHO) and Penn Medicine tools, covering demographics, COVID-19 history, and PCC symptoms. PCC was defined as symptoms starting three months after the post-acute infection and lasting for at least two months beyond. Statistical analyses employed descriptive statistics, chi-square tests, and a logistic regression model, with a significance level of p < 0.05. ResultsA total of 1546 patients were enrolled. Their mean age was 39.7 ± 15.9 years, 46.0 % were males, and 13.9 % had comorbidities. Of them, 760 patients (49.2 %) reported PCC symptoms including, 52.6 % seen at outpatients, 26.7 % were admitted, and 0.5 % required admission to ICU. PCC symptoms included shortness of breath (94.2 %), mood changes (13.9 %), cough (13.0 %), and fatigue (8.8 %). PCC was associated with older age, hospitalization during acute COVID-19, comorbidities including asthma, hypertension, and diabetes, as well as treatment with different COVID-19 medications. Logistic regression shows that asthma, male gender, and treatment with medicines at the hospital remained significant in the model (ORs: 6.85, 0.36, and 0.88, p < 0.001). ConclusionThis study sheds light on PCC's prevalence and influencing factors following infection in Alexandria, Egypt. Common PCC symptoms included difficulty in breathing, fatigue, and psychological manifestations. The findings emphasize the critical need for early intervention and targeted management strategies, especially for high-risk groups such as asthma patients, to alleviate the long-term health consequences of COVID-19. Study results could guide the prevention of PCC e.g., through vaccination, management of long-term sequelae of PCC e.g., rehabilitation, and psychological support initiatives.

Predictors of Adherence to Antiretroviral Therapy among People Living with HIV in Northern Egypt.

Background: Adherence to medications is a crucial factor in achieving the best therapeutic outcomes for patients who have human immunodeficiency virus (HIV). Little is known about the rate and predictors of adherence to antiretroviral therapy (ART) in Egypt. Objectives: To assess the degree of adherence to ART among people living with HIV/AIDS (PLWHA) in Egypt and to explore the predictors of non-adherence. Methods: A cross-sectional study was conducted from January 2021 to December 2021 on 785 PLWHA attending an ART clinic at the main fever hospital in Alexandria, Egypt. Data collection was done using an interviewing questionnaire and pharmacy database records. Multivariate logistic regression analysis was done to identify the predictors of adherence to ART. Results: The overall adherence rate to ART among the study subjects was 66.7%. Female sex (Adjusted Odds Ratio [95% CI]: 1.73 [1.01-2.96]), intravenous drug use (AOR [95% CI]: 2.87 [1.27-6.49]), fair satisfaction with the health service at ART clinics (OR [95% CI]: 1.86 [1.27-2.73]) appeared as independent predictors of poor adherence. Conclusion: The degree of adherence to ART among PLWHA in Egypt is noticeably high, although it was influenced by several patient-, healthcare-, and community-related factors. This work provides an accurate, standardized tool to measure adherence and identify factors that contribute to non-adherence.

Prospective comparative study of medial parapatellar and medial subvastus approaches in total knee arthroplasty

Introduction Total knee arthroplasty (TKA) is the treatment of end-stage osteoarthritis in patients who failed to respond to conservative treatment in providing significant pain relief and improving joint function. The medial parapatellar approach (MPP) allows adequate patellar eversion and sufficient knee flexion to expose the knee joint, but the incision through the quadriceps tendon may impair the extensor mechanism of the knee post-operatively. The subvastus approach (SV) completely spares both the quadriceps tendon and muscle and provides adequate exposure of the knee joint for the replacement procedure, SV maintains integrity of the patellar blood supply and reduces post-operative pain resulting in shorter hospital stay.The aim of this prospective study was to compare the results of the medial parapatellar and subvastus approaches in primary total knee arthroplasty (TKA) regarding postoperative pain, recovery of muscle strength, range of knee motion and return to regular daily activities.Materials and Methods Sixty patients underwent TKA at El-Hadara university hospital in Alexandria. The medial parapatellar apphroach (MPP) was performed in 30 patients while the subvastus approach (SV) was used for the other 30 patients. The choice of approach was randomly assigned.Results The statistical analysis of the results at the end of a 6-month follow-up showed that there were no significant differences between the patients in group 1 (MPP) and group 2 (SV) with respect to age, gender, comorbidity, side operated or body mass index (BMI). Regarding the functional knee scores (IKDC, WOMAC), there were no differences at 4 weeks, 3 months and 6 months postoperatively between the two groups. However, we found better outcomes in the SV group regarding the VAS score during the first five postoperative days, earlier quadriceps recovery by assessment of Straight Leg Raising test (SLR), while the operative time was longer in the SV group with less blood collected postoperatively in hemovac drain in the same group.Discussion In our study during the operation via the MPP approach, the index suture positioned at the superomedial border of the patella and the opposite suture on the medial retinacular flap had enabled the surgeon to avoid patellar maltracking during closure of the wound. In the SV group, the L-shaped incision of the medial capsule was considered an efficient landmark for accurate soft tissue closure avoiding the patellar maltracking.Conclusion The subvastus approach offers the advantage of keeping the integrity of quadriceps muscle and the extensor mechanism remains intact post-surgery. It causes less pain and less blood loss postoperatively than the regular parapatellar approach. The patient could recover the knee function in a shorter time with fewer complications, which is greatly in line with the concept of ERAS (Enhanced Recovery After Surgery).

Depressive Symptoms among Nurses in Al Maamoura Psychiatric Hospital in Alexandria, Egypt

Depressive Symptoms among Nurses in Al Maamoura Psychiatric Hospital in Alexandria, Egypt

Depressive symptoms and coping patterns in a sample of Egyptian mothers of ADHD children

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is considered to be one of the most common neurodevelopmental conditions found in children. The global prevalence in the age group 6–17 years falls between 2 and 18%. Studies have found that mothers of ADHD children are more prone to experience depression, anxiety, social isolation, stress, and self-blame.Aims and objectivesTo assess the prevalence of depression and its severity among mothers with children found to have ADHD compared to mothers of the control group, we also investigate the coping mechanisms employed by mothers with ADHD children and identify any potential correlation between coping strategies utilized by mothers in the case group and the severity of depression.Patients and methodsIn this cross-sectional study, we recruited 100 participants from the outpatient child psychiatry clinic at Ma’amoura Psychiatric Hospital in Alexandria, Egypt. Two participant groups were assembled: Group I (case) consisted of 50 mothers whose children had ADHD, and Group II (control) consisted of 50 mothers whose children did not have ADHD. Both groups underwent the General Health Questionnaire (GHQ-28), Beck Depression Inventory (BDI-II), and Coping Orientation to Problems Experienced (COPE) inventory.ResultsA significant relationship was observed between the Beck Score and hyperactive and combined ADHD types; however, no significant correlation was found between the Beck Score and the inattentive ADHD type. Regarding the coping styles with stress, the current study’s results found that in (case group) turning to religion had the highest sub-scale mean, followed by seeking social support and emotional support, while the lowest sub-scale score mean was humor, followed by denial. By employing univariate logistic regression analysis to identify depression predictors in group I, the results showed that the increase in the score of less useful coping by 1 was a probable factor to increase the possibility of depression by OR = 1.438 (1.186–1.743). Combined and hyperactive ADHD types were found to increase the risk of depression by OR 6.706 (1.309–34.353).ConclusionDepressive complaints were more prevalent among mothers of children with ADHD compared to the control group. We found a statistically important relationship between Beck Depression Scores (depressive symptom severity) in mothers with ADHD children and having hyperactive or combined ADHD types in their children. We also found a statistically significant positive correlation between the severity of depression and some coping styles as turning to religion and seeking social support.

Alternations in miR-155 and miR-200 serum levels can serve as biomarkers for COVID-19 in the post-mass vaccination era.

Mass vaccination and natural immunity reduced the severity of COVID-19 cases. SARS-CoV-2 ongoing genome variations imply the use of confirmatory serologic biomarkers besides PCR for reliable diagnosis. MicroRNA molecules are intrinsic components of the innate immune system. The expression of miR155-5p and miR200c-3p was previously correlated with SARS-CoV-2 pathogenesis. This case-control study was conducted during the third peak of the COVID-19 pandemic in Egypt and aimed to calculate the accuracy of miR155-5p and miR200c-3p as biomarkers for COVID-19. Thirty out of 400 COVID-19 patients at a main University hospital in Alexandria were included in the study along with 20 age-matched healthy controls. Plasma samples were collected for total and differential CBC. Relative quantitation of miR155-5p and miR200c-3p expression from WBCs was done by RT-qPCR. The expression of miR155-5p and miR200c-3p was positively correlated and was significantly downregulated in COVID-19 patients compared to the healthy control group (p ˂ 0.005). Both miR155-5p and miR200c-3p were of 76% and 74% accuracy as diagnostic biomarkers of COVID-19, respectively. Regarding the differentiation between mild and moderate cases, their accuracy was 80% and 70%, respectively. miR155-5p and miR200c-3p expression can be used to confirm the diagnosis of COVID-19 and discriminate between mild and moderate cases, with a moderate degree of accuracy.

Exploring anti-quorum sensing potential and biofilm inhibitory effect of azithromycin against urinary Escherichia coli isolated from a teaching hospital in Alexandria

Exploring anti-quorum sensing potential and biofilm inhibitory effect of azithromycin against urinary Escherichia coli isolated from a teaching hospital in Alexandria

Entrepreneurial leadership, nurses' proactive work behavior, and career adaptability: a structural equation model.

Healthcare organizations with practitioners who exhibit proactive work behavior and career adaptability acquire a competitive advantage in the face of many adversities. Entrepreneurial leadership (EL) is a new leadership approach that has a huge impact on followers' behavior, although research into its theory and empirical evidence is still in its infancy. A non-probability convenience sample methodology (n = 450) was utilized to choose study participants, who were equally dispersed among the two private hospitals in Alexandria. A cross-sectional study was carried out in all departments of the hospitals, which were chosen at random using a simple random procedure. Three validated scales were used in this study to measure the study variables and establish a structural equation model. The result of this study revealed that nurses perceived moderate mean scores of all variables; entrepreneurial leadership (140.84 ± 11.94), proactive work behavior (46.02 ± 5.85), and career adaptability (85.55 ± 10.35). In addition, the structured equation model revealed a goodness fit index and presents that entrepreneurial leadership significantly affects nurses' proactive work behavior with an estimated β of 0.555, coefficient of regression C.R. of 4.006, at P value < 0.001. Also, it significantly affects career adaptability with an estimated β of .834, a coefficient of regression C.R. of 3.491 at P value < 0.001. The developed structural equation model confirmed the significant impact of entrepreneurial leadership (EL) on nurses' proactive work behavior (PWB) and career adaptability (CA)". Therefore, this study offers important implications for nurse managers, staff nurses, hospital human resources management practice, and academics.

Effect of a Nurse-Led Rehabilitation Program: A Quasi-Experimental Study Examining Functional Outcomes in Patients With Hand Burns.

The model of early rehabilitation for people with burns is still relatively novel in developing countries such as Egypt. The study examined the effect of a nurse-led rehabilitation program on functional outcomes in patients with severe hand burns. A quasi-experimental design was used in this study. The study was completed in the burn unit of a teaching university hospital in Alexandria, Egypt, with a convenience sample of 80 patients with severe hand burns. Participants were consecutively assigned to one of two groups: control ( n = 40), which received only routine hospital care and clinical interventions, or intervention ( n = 40), which received routine hospital care and clinical interventions and a 4-week nurse-led rehabilitation program (health education including audiovisual aids and burn rehabilitation education booklet, social support, and hand rehabilitation exercises). To assess functional outcomes, both groups were given pre- and posttests of the Disabilities of the Arm, Shoulder and Hand outcome and the Hand Motor Function Observational Checklist questionnaires. Descriptive and inferential statistics were conducted. Functional outcomes were significantly improved in the intervention participants compared to the control participants ( t = 5.710, p < .001). The differences in index scores between the two groups were statistically significant ( p < .001). The study provides information for burn rehabilitation nurses in developing countries to develop and test early interventions that improve functional outcomes in this population. A 4-week nurse-led program may be a beneficial intervention for improving functional outcomes in adult patients with severe hand burns who are undergoing rehabilitation.

Collaborative leadership and productive work performance: The mediating role of nurses'innovative behavior.

This study aims to explore the relationship between collaborative leadership and nurses' productive work performance as well as the mediating role of nurses' innovative behavior in this relationship. Collaborative leadership is an imperative necessity in the contemporary turbulent healthcare environment as it provides a collaborative atmosphere where innovative behavior and productive performance of nurses are fostered, hence moving healthcare organizations toward competitiveness and sustainability. A cross-sectional descriptive correlational exploratory research design was used to conduct the study. Data were collected from 550 nurses recruited from three large university hospitals in Alexandria, Egypt, using three instruments, namely, interprofessional collaborative leadership in healthcare teams scale, productive work performance questionnaire, and innovative behavior inventory. The instruments of the study are Likert-type questionnaires through which nurses' perspectives regarding study variables were investigated. We used descriptive statistics, inferential statistics as well as structured equation modeling (SEM). SEM revealed that collaborative leadership accounted for 83% of the variance of individual productive work performance and 77% of the variance of nurses' innovative behavior. Moreover, nurses' innovative behavior partially mediates the relationship between collaborative leadership and their productive work performance. Collaborative leadership practices are powerful strategies to enhance the innovative behavior of nurses and sustain their productive work performance. Fostering a collaborative atmosphere in workplace is mandatory for nurses' innovativeness. Replacing hierarchal leadership styles with collaborative ones is a promising strategy to enhance the productive performance of nurses. Healthcare managers and leaders could cultivate an interprofessional collaborative culture in the workplace in order to sustain productivity and eradicate counterproductive work behaviors among healthcare providers.

Acceptability and feasibility of delivering family intervention for caregivers of patients with schizophrenia in Egypt

Background: In Egypt as elsewhere, patients with schizophrenia and their families confront unique obstacles. This study examined the views of important stakeholders’ on the feasibility, approval, and obstacles of family intervention programs for schizophrenia in Egypt to address these issues. Objective: The aim of the study was to investigate the perspectives of stakeholders regarding the feasibility, acceptability, and obstacles associated with providing family intervention for schizophrenia in Egypt. Methods: The research took place at El-Maamoura Hospital in Alexandria and included a total of 37 participants. These participants were divided into seven focus groups, with 25 individuals being health professionals and the remaining 12 individuals being caregivers. Concurrently, data collection and analysis were carried out using the qualitative research method, employing the framework analysis to process the transcripts. Results: The participants highlighted the importance of families feeling accepted and well-informed regarding the nature of the illness. In conclusion, the participants suggested making changes to the intervention’s content by incorporating details about the illness, providing emotional support, and including culturally appropriate coping mechanisms. Conclusion: In conclusion, it is determined by the study that before implementing family intervention for schizophrenia, it is crucial to make cultural adjustments to ensure its acceptability. The findings of the study offer valuable insights for the development and execution of family intervention programs for schizophrenia in Egypt. Implication for Clinical Practice: It is crucial to culturally adapt a modified family interventions to cater to the cultural requirements of families and healthcare professionals in Egypt, as this could potentially result in improved outcomes for patients diagnosed with schizophrenia and their families.

The illness perceptions of patients with percutaneous coronary intervention compared to patients with no percutaneous intervention, for acute myocardial infarction, in cardiac rehabilitation.

Patients who receive percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) have been found to have low attendance at cardiac rehabilitation (CR). It has been suggested that this is because PCI patients have a benign perception of their coronary disease; however, this has never been quantitatively investigated. The aim of this prospective study was to evaluate the illness perceptions (IP) of patients with AMI treated with PCI. The Heart Health Illness Perception Questionnaire (modified version of the Brief Illness Perception Questionnaire) and the Cardiac Beliefs Questionnaire were used to assess patients' IP and cardiac disease misconceptions, respectively. Patients in phase 2 of CR were recruited from the Royal Alexandria Hospital, Paisley, UK. One hundred two patients were identified from the cardiac unit database over a 16-week period and sent questionnaires. Fifty-six patients returned questionnaires suitable for analysis (54.9% response rate). There was a significant difference in the IP scores of the 3 groups [primary-PCI (pPCI) = 0.18 ± 1.44, elective-PCI = 5.27 ± 15.65, non-PCI = 9.94 ± 11.19; P = 0.046]. PCI patients had a significantly lower IP score than non-PCI patients (PCI = 1.62 ± 12.76, non-PCI = 9.94 ± 11.19; P = 0.027). pPCI patients had a significantly lower IP score than non-pPCI patients (pPCI = 0.18 ± 11.44, non-pPCI = 8.04 ± 13.11; P = 0.021). Of the PCI patients 22.9% agreed they were 'fixed for life' and a lower IP score was found to predict this opinion (P = 0.032). PCI patients, particularly pPCI patients, perceive their coronary disease to be relatively benign. Further research is required to investigate if this predicts poor attendance at CR.

Genotyping and susceptibility testing uncovers large azole-resistant Candida tropicalis clade in Alexandria, Egypt

Candida tropicalis is an emerging medically relevant Candida species. The yeast primarily causes opportunistic infections in intensive care units and is highly prevalent in tropical countries. The genetic diversity within this species is high, and nosocomial transmission has been reported. C. tropicalis genotyping of isolates from low- and middle-income countries is underrepresented when compared with that from high-income countries. Also, in Egypt, only limited genotyping has been conducted for C. tropicalis isolates, while antifungal resistance seems to increase, especially against azoles. Antifungal susceptibility testing was performed on 64 C. tropicalis isolates from ICU patients collected from multiple hospitals in Alexandria, Egypt. Genotyping by means of short tandem repeat (STR) and whole genome sequencing (WGS) single nucleotide polymorphism (SNP) analysis was performed. Using antifungal susceptibility testing, fluconazole resistance was observed in 24 isolates (38%), of which 23 harboured an ERG11 G464S substitution, previously shown to cause resistance in Candida albicans. STR genotyping showed that these 23 isolates were related, forming a distinct resistant clade. WGS SNP analysis subsequently confirmed this genetic relationship, although isolates within this clade differed in at least 429 SNPs, suggesting that these were independently introduced. Overall, STR and WGS SNP analysis of this collection indicates limited C. tropicalis nosocomial transmission in Alexandria, while the presence of this large azole-resistant C. tropicalis clade within this city hampers the treatment of intensive care unit patients.

Survey to measure the quality of life of patients with tuberculosis in Alexandria, Egypt: a cross-sectional study

BackgroundAssessment of quality of life (QoL) in patients with tuberculosis (TB) may improve healthcare providers’ understanding of the disease burden. This study aimed to investigate the QoL of patients with TB in Alexandria, Egypt.MethodsThis cross-sectional study was conducted in chest clinics and main chest hospitals in Alexandria, Egypt. A structured interview questionnaire was used to collect data from participants through face-to-face interviews from November 20, 2021, until the June 30, 2022. We included all adult patients aged 18 years or above during the intensive or continuation phase of treatment. The World Health Organization (WHO) WHOQOL-BREF instrument was used to measure QoL, which includes the physical, psychological, social relationships, and environmental health domains. Using propensity score matching, a group of TB free population was recruited from the same setting and completed the questionnaire.ResultsA total of 180 patients participated in the study: 74.4% were males, 54.4% were married, 60.0% were 18–40 years old, 83.3% lived in urban areas, 31.7% were illiterate, 69.5% reported insufficient income, and 10.0% had multidrug-resistant TB. The TB-free population group had higher QoL scores than the TB patients’ group: (65.0 ± 17.5 vs. 42.4 ± 17.8) for the physical domain, (59.2 ± 13.6 vs. 41.9 ± 15.1) for the psychological domain, (61.8 ± 19.9 vs. 50.3 ± 20.6) for the social domain, (56.3 ± 19.3 vs. 44.5 ± 12.8) for the environment domain, (4.0(3.0–4.0) vs. 3.0(2.0–4.0)) for general health, and (4.0(3.0–4.0) vs. 2.0(2.0–3.0)) for the general QoL, P < 0.0001. Patients with TB aged 18–30 years had the highest environmental score compared with the other age groups (P = 0.021).ConclusionsTB had a significant negative impact on QoL, with the physical and psychological domains being the most affected. This finding necessitates strategies to improve QoL of patients with to enhance their compliance to treatment.

Prevalence and determinants of antimicrobial resistance of pathogens isolated from cancer patients in an intensive care unit in Alexandria, Egypt

BackgroundInfections caused by multidrug-resistant organisms (MDROs) are a globally increasing threat among critically ill patients, especially those with underlying malignancies. We aimed to assess the prevalence and susceptibility patterns of MDROs among cancer patients in intensive care units (ICU), and their predictors.MethodsOver 4 years, we retrospectively reviewed medical records of 497 malignancy patients in the ICU of a tertiary hospital in Alexandria, Egypt. The data for various factors, such as demographic characteristics, comorbidities, causative pathogen, and antimicrobial resistance (AMR), were collected and analyzed using univariate analysis. Logistic multivariate regression analysis was used to estimate the probability of developing MDROs among this population.ResultsA total of 748 isolates were obtained from 1249 specimens. Gram-negative bacteria detected (459) comprised 61.4% of all isolates, while only 75 (10%) were gram-positive, and 214 (28.6%) were fungal pathogens. The most frequently encountered isolate was Klebsiella pneumoniae (n = 183), of which 107 were carbapenem-resistant (CR) and 62 were extended-spectrum beta-lactamase (ESBL)-producing. This was followed by Escherichia coli (n = 136), of which 17 were CR and 100 were ESBL-producing strains, while 3 were resistant to quinolones. Acinetobacter baumannii came in third (n = 67), with 63 being CR. The overall susceptibility of gram-negative bacteria was recorded as highest to colistin (97.3%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcal species among gram-positive bacteria were 54.6% and 33.3%, respectively, with no resistance reported to vancomycin or linezolid. Among the MDRO infection predictors were neutropenia, recent antibiotics use, and receiving chemotherapy. Neutropenia had the highest odds ratio (OR: 2.3, CI: 1.28–4.09), followed by recent antibiotics use (OR: 1.8, CI: 1.22–2.59).ConclusionGram-negative bacilli were the most frequently reported MDROs, with resistance to higher generation cephalosporins and even carbapenems limiting antibiotic treatment options to older class antibiotics, such as colistin, with potential side effects, including nephrotoxicity. Estimating AMR probability using the prediction model of risk factors, such as neutropenia and previous antibiotics use, may be functional in the rapid identification of higher-risk patients.