Our data indicate that prior CMV infection, in contrast to optimal atherectomy, is not associated with chronic restenosis after conventional coronary balloon angioplasty. The results do not support a possible benefit from antiviral therapy.

Pseudomonas bacteria are widespread pathogens that account for considerable infections with significant morbidity and mortality, especially in hospitalized patients. The Pseudomonas genus contains a large number of species; however, the majority of infections are caused by Pseudomonas aeruginosa, infections by other Pseudomonas species are less reported. Pseudomonas stutzeri is a ubiquitous Gram-negative bacterium that has been reported as a causative agent of some infections, particularly in immunocompromised patients but has rarely been reported as a cause of infective endocarditis. Here, we report a case of a 55-year-old female with no significant medical history who presented with exertional dyspnea, productive cough, and fever. She was diagnosed as a case of acute anterior ST myocardial infarction, underwent double valve replacement surgery, and was found to have infective endocarditis caused by Pseudomonas stutzeri.

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This study aimed to characterize the HCV genetic subtypes variability and the presence of natural occurring resistance-associated substitutions (RASs) in Saudi Arabia patients. A total of 17 GT patients were analyzed. Sequence analysis of NS3, NS5A, and NS5B regions was performed by direct sequencing, and phylogenetic analyses were used to determine genetic subtypes, RAS, and polymorphisms. Nine patients were infected by GT 4a, two with GT 4o and three with GT 4d. Two patients were infected with apparent recombinant virus (4a/4o/4a in NS3/NS5A/NS5B), and one patient was infected with a previously unknown, unclassifiable, virus of GT 4. Natural RASs were found in six patients (35%), including three infected by GT 4a, two by GT 4a/GT 4o/GT 4a, and one patient infected by an unknown, unclassifiable, virus of GT 4. In particular, NS3-RAS V170I was demonstrated in three patients, while NS5A-RASs (L28M, L30R, L28M + M31L) were detected in the remaining three patients. All patients were treated with sofosbuvir plus daclatasvir; three patients were lost to follow-up, whereas 14 patients completed the treatment. A sustained virological response (SVR) was obtained in all but one patient carrying NS3-RAS V170I who later relapsed. GT 4a is the most common subtype in this small cohort of Saudi Arabia patients infected with hepatitis C infection. Natural RASs were observed in about one-third of patients, but only one of them showed a treatment failure.

Background Coronavirus disease 2019 (COVID-19) is a rapidly spreading infection that is on the rise. New variants are continuously appearing with variable degrees of lethality and infectivity. The extensive work since the start of the pandemic has led to the evolution of COVID-19 vaccines with varying mechanisms. We aim to determine real-world data by looking at the different clinical outcomes associated with COVID-19 vaccination, focusing on the rate of hospitalization, severity, and mortality. Methodology A retrospective observational study included 624 patients with COVID-19 infection who were hospitalized at King Fahad Hospital of the University and King Fahad Military Medical City between April and July 2021. The cohort was divided into 3 groups: unvaccinated, partially vaccinated (PV), and fully vaccinated (FV). The severity and outcome of COVID-19 disease were compared among the three groups. Among the vaccinated group, we studied the effect of vaccine type on the severity and outcome of COVID-19 disease. Results We found that 70.4% of patients with COVID-19 disease who required hospitalization were unvaccinated. Un-vaccination was a significant predictor of critical COVID-19 disease (OR 2.31; P <0.001), whereas full vaccination was associated with significantly milder disease severity (OR 0.36; P 0.01). Moreover, un-vaccination status was an independent predictor of longer hospitalization (OR 3.0; P <0.001), a higher requirement for ICU admission (OR 4.7; P <0.001), mechanical ventilation (OR 3.6; P <0.001), and death (OR 4.8; P <0.001), whereas the FV group had a lower risk of ICU admission (OR 0.49; P 0.045). Unvaccinated patients with comorbidities had worse severity and outcome of COVID-19 infection (P<0.05). Both vaccine types (Pfizer and AstraZeneca) had similar protective effects against the worst outcomes of COVID-19 disease. Conclusion COVID-19 vaccination has been shown to be effective in reducing hospitalization, the severity of COVID-19 infection, and improving outcomes, especially in high-risk group patients. COVID-19 vaccination programs should continue to improve the outcome of such a disease.

Background: The efficacy of condom use in declining HIV transmission may be compromised by their incorrect usage. Much focus has been paid on the regularity of condom usage but consumer mistakes and challenges must be considered. Breakage, slipping, leakage, incomplete use and other problems during the sexual event may compromise the protective role of the condom. Objective: To evaluate through a systematic review of published data, the type, and incidence of error and problems in condom use, and their possible role in reducing the preventive action of condoms. Methods: A systematic literature search for peer-reviewed articles published between January 2000 and January 2019, issued in English in peer-reviewed journals, and reporting the occurrence of condom errors/problems among HIV high-risk populations. Results: Twenty studies representing nine countries met the inclusion criteria. The most predominant mistakes associated with condom use included condom breakage, slippage, delayed condom application, early removal, issues related to erection loss and difficulties with fit and feel were reported, failure to squeeze out air, use of expired condoms, reuse of condom, and wearing the condom outside out were other issues noticed. Conclusions: Condom use problems and mistakes are prevalent across the globe. Educational efforts are needed to empower HIV the at-risk population with confidence and knowledge to improve correct condom use and increase preventive activity

<b>Introduction:</b> End-of-life medical care (ELMC) plans and do-not-resuscitate (DNR) decision-making are usually affected by multiple factors compared to other medical care decisions.<b> </b>ELMC and DNR policy implementation are still diversified and heterogeneous, especially in Saudi Arabia, because policymakers have adopted no guidelines. Thus, this study investigated physicians’ knowledge, attitude, and practice regarding ELMC and DNR.<br /> <b>Methods:</b> A cross-sectional study design was adopted. Three hundred physicians working at King Fahad Hospital of the University, Khobar, Saudi Arabia, were randomly selected and administered an anonymous self-administered questionnaire using the Likert scale. Data analysis was carried out using SPSS 23.0.<br /> <b>Results: </b>Of 300 distributed questionnaires, 264 (88%) were completed and analysed. Knowledge gaps and negative attitudes were observed, a quarter of the participants were opposed to issuing a DNR order, and 29.0% considered DNR as equal to euthanasia as they practice. The participants’ patient age and religious factors were the most critical factors in the ELMC plan and DNR decision. The physician’s level of acceptance regarding a set of ELMC interventions and DNR decisions showed heterogenicity and uncertainty among participants.<br /> <b>Conclusions:</b> The ELMC plan and DNR decision-making should be appropriately addressed in the medical residents’ training programs to bridge the knowledge gap and the physicians’ negative attitudes during their practice. Additionally, there is a need to update and unify the DNR policies at the national level, considering the patient’s right to be informed and involved actively during the decision process making. Finally, more prospective research is needed for the global standardization of ELMC.

ObjectivesPredictors of the efficacy of highly active antiretroviral therapy (HAART) have been investigated in several studies. To increase current knowledge, the study aimed to acquire comprehensive data over an extended observation time, to obtain information on possible performance differences among individual drugs, and to identify factors with influence on the initial response to a HAART regimen and the sustainability of the response. MethodsThe data were obtained from a prospective, single University Medical School HIV cohort. Clinical, laboratory, and treatment parameters for 475 patients were collected over 4.5 years. HAART efficacy was determined by analysis of variance and multivariate survival analysis. ResultsThe overall initial complete response (CR) (o500 HIV-1 RNA copies/mL) was 76.3%. Use of indinavir [odds ratio (OR) 5 2.747, P 5 0.0009] and the number of new nucleoside reverse transcriptase inhibitors (NRTIs) (OR 5 1.862, P 5 0.0017) were positively associated with CR, while initial peripheral blood HIV RNA concentration (OR 5 0.383, Po0.0001), use of saquinavir hard gel capsules (OR 5 0.531, P 5 0.0302), the number of successive HAART regimens (OR 5 0.631, Po0.0001), and the number of previously used NRTIs (OR 5 0.728, P 5 0.0081) were negatively associated with CR. Sustainability of CR was positively correlated with use of indinavir [hazard ratio of relapse (HR) 5 0.255, Po0.0001] and haemoglobin levels (HR 5 0.873, P 5 0.0124), but negatively correlated with initial HIV RNA concentration (HR 5 1.273, P 5 0.0003) and the number of previously used NRTIs (HR 5 1.587, Po0.0001). A higher number of consecutive HAART regimens was associated with a markedly reduced CR, but with only a slightly higher risk of relapse. ConclusionsThe initial response to HAART, as well as long-term efficacy, depends strongly on a few fundamental parameters that can easily be assessed in a clinical setting. There is a need for effective suppression of HIV replication over decades, and these factors should be considered early in treatment planning to identify patients with an unfavourable profile of risk factors for treatment failure.Keywords: antiretroviral therapy, HIV-1, observational cohort, response, treatment efficacy IntroductionA breakthrough in antiretroviral therapy (ART) was achieved by trials using triple drug regimens containing a protease inhibitor (PI), demonstrating clinical endpoint benefits (progression to AIDS or death) and sustained improvement of the surrogate markers CD4 lymphocyte count and virus concentration [1,2]. PI-containing triple drug regimens, the first kind of highly active antiretroviral therapy (HAART), led to an impressive reduction of HIVrelated morbidity and mortality [3], and replaced single or dual nucleoside reverse transcriptase inhibitor (NRTI) therapies. This first phase of HAART was characterized by a high proportion of patients who were pretreated with NRTIs, despite lack of data demonstrating substantial A number of recent studies focused on certain aspects and predictive ...