Hospitals In Makkah Research Articles

Antimicrobial resistance among pilgrims: a retrospective study from two hospitals in Makkah, Saudi Arabia

To identify commonly reported community-acquired organisms and antimicrobial resistance patterns exhibited by Gram-positive and Gram-negative pathogens among pilgrims visiting emergency care departments in Makkah. The study was designed as a retrospective audit of all patients (pilgrims) admitted to two hospitals and residing in the city of Makkah, SaudiArabia. Among 374 isolates, Gram-negative pathogens accounted for 280 (75%), while the remaining 94 (25%) were Gram-positive organisms. Among all isolated pathogens, the highest resistance was observed for amoxicillin-clavulanic acid. Klebsiella pneumoniae had the highest resistance to amoxicillin-clavulanic acid and ampicillin. Most of the organisms were sensitive to tobramycin except Acinetobacter baumannii (n=3, 50%), Escherichia coli (n=4, 57%), and K. pneumoniae (n=6, 46%). Overall, a high resistance was observed for beta-lactam antibiotics. In addition, a high resistance was noted for ceftazidime with A. baumannii species (n=16, 77%). However, for quinolones, the highest resistance to ciprofloxacin was observed for E. coli, A. baumannii, methicillin-resistant Staphylococcus aureus, and K. pneumoniae.

Characteristics of monitored diabetic patients by glycated haemoglobin (HbA1c)

Glycated haemoglobin (HbA1c) test indicates the blood glucose levels for the previous two to three months. Using HbA1c test may overcome many of the practical issues and prevent infections such as urinary tract infections (UTIs). The study aimed to evaluate the impact of glycemic control using HbA1c test to understand patient characteristics and UTIs prevalence. Glycemic control was evaluated by measuring HbA1c for a total of 208 diabetes patients who were regularly attending diabetes center in Al-Noor specialist hospital in Makkah. The results showed that good and moderate glycemic controlled patients were 14.9% and 16.9% respectively while the poor glycemic patients were 68.3%. Among the good improved glycemic control, 83.9% were females, 48.4% were from age group (15-44y). Among the moderately improved glycemic control, 68.4% were females, 54.3% were from age group (45-64 y) with no significant difference. The total number of the patients with positive UTIs was 55 (26.4%) while the total number of patients with negative was UTIs 153 (73.6%). Among the positive UTIs, 76.3% were with poor glycemic control while only 12.3% and 11% were moderate and good improved glycemic control respectively. Among the negative UTIs, 65.3% were with poor glycemic control while only 19% and 15.7% were with moderate and good improved glycemic control respectively. Prevalence of UTIs among diabetic patients was not significant (p > 0.05). It was concluded that HbA1c was useful monitoring tool for diabetes mellitus and may lead to improved outcomes. Using a HbA1c test may overcome many of the practical issues that affect the blood glucose tests.

Contributing factors for acquired muscle weakness in intensive care unit

Introduction: One of the complications of intensive care unit (ICU) admission is neuromuscular dysfunction because of critical illness, which may lead to disuse atrophy. Many of critically ill patients have severe muscle weakness, which has been termed ICU-acquired weakness (ICU-AW). ICU-AW has many consequences on patients’ outcome. The aim of the study was to determine contributing factors for occurrence of acquired muscle weakness in intensive care units. Setting: The study was conducted in four general ICUs in two selected Hospitals in Makkah in KSA. Subjects: Hundred patients were included in the study. Materials and Method: Tool one: factors contributing to ICU-AW assessment tool. Tool two: indicators of ICU-AW in critically ill patients. Results: Forty-two patients were diagnosed ICU-AW. Differences between the ICU-AW group and the no ICU-AW group in: sex, diagnosis on admission and APACHE II were not statistically significant. Age in the ICU-AW group was higher than in no ICU-AW group [59±14 vs. 53±11 years, p = .0183] which was significant statistical difference. Conclusion: The contributing factors for ICU-AW are immobility, patients’ age, level of consciousness, parenteral nutrition, and glucocorticoid & insulin therapy.

Antimicrobial resistance patterns of Pseudomonas aeruginosa in tertiary care hospitals of Makkah and Jeddah.

BACKGROUNDThe clinical significance of Pseudomonas aeruginosa has greatly increased due to its ability to rapidly develop resistance to major groups of antibiotics.OBJECTIVESOur objective was to determine the pattern of antimicrobial resistance of P aeruginosa.DESIGNProspective, descriptive study.SETTINGFour tertiary care hospitals in Makkah and Jeddah.METHODSClinical isolates of P aeruginosa were processed following standard microbiological procedures. A Microscan Walk Away system was used for the identification and antibiotic susceptibility of P aeruginosa isolates.MAIN OUTCOME MEASURESPercentage of resistance of P aeruginosa to antibiotics.RESULTSThe overall drug resistance among 121 strains of P aeruginosa was low to moderate to commonly used anti-pseudomonal drugs (4.9% to 30.6%). Significantly less resistance was exhibited by piperacillin-tazobactam (4.9%; P<.05) and meropenem showed significantly high resistance (30.6%; P<.05) as compared to other antibiotics, followed by ticarcillin (22.3%) and imipenem (19%), irrespective of the site of infection. The antibiotics with <10% resistance were cefepime (8.3%), amikacin (7.4%) and piperacillin-tazobactam, which showed lowest resistance (4.9%). Although, data varied between hospitals, meropenem and ticarcillin had the highest drug resistance in all hospitals. Multidrug resistance was 10.7%.CONCLUSIONLow-to-moderate rates of drug resistance among P aeruginosa isolates were observed. Meropenem resistance was high irrespective of the site of infection. This pattern of resistance indicates probable overuse of broad-spectrum antibiotics like carbapenems. Overuse needs to be addressed by each institution, and consideration given to regulating use of broad-spectrum antibiotics.LIMITATIONSResults cannot be generalized as the study did not include all tertiary hospitals in these cities.

English

The study of prescribing pattern is a significant constituent of medical review, which helps in monitoring, evaluating and building required modifications in the prescribing practices to attain a rational and cost effective medical care. The present study determined the trends in drug prescription pattern of clinicians in private and general hospitals in Makkah, Saudi Arabia. One thousand two hundred and thirty two prescriptions were collected from private and general hospitals between March and September, 2013. The prescriptions were subjected to analysis using the World Health Organization (WHO) drug use indicators. The study cleared that all collected prescriptions were titled with the name of hospital and some were handwritten and the others were computer printouts. Readability was evident in 58.3% of handwritten prescriptions. The name, address, date, license number, and signature of the prescriber was presented in 71.8, 95.1, 71.8, 47.4 and 77.9% of all prescriptions, respectively. Name of patient, age, sex and address were presented in 81.5, 64.0, 61.0 and 20.5% in all prescriptions, respectively. The diagnosis of complaint or a history of allergy was presented in 44.5 and 12.7%, respectively of all prescriptions. The prescribed drugs in a generic name were 32.8% of all prescriptions. The strength, the drug dosage form, the route and frequency of administration of the prescribed drug were presented in 84.1, 58.1, 33.8 and 93.2% of all prescriptions, respectively whereas, duration of treatment was mentioned in only 12.0% of total prescriptions. The average number of drugs per encounter was 2.8. Prescribers were prescribed one, two, three, four, five or more than five drugs per prescription in 1.7, 41.1, 35.3, 16.2, 3.7 and 2.3%, respectively. This study revealed that it is necessary to further improve drugs prescribing practice. This calls for sustained interventional strategies and periodic review at all levels of healthcare for the avoidance of negative consequences of inappropriate prescription. Polypharmacy and low rate of generic prescriptions remain problems in healthcare facilities. Key words: Prescribing practice, drug use indicator, hospitals, prescriptions.

Molecular characterization of extended-spectrum beta-lactamases (ESBLs) produced by clinical isolates of Acinetobacter baumannii in Saudi Arabia.

BackgroundAcinetobacter baumannii is a common opportunistic pathogen that causes major nosocomial infections in hospitals. In this study, we hypothesized a high prevalence of A. baumanni ESBL (extended-spectrum beta-lactamase) among all collected isolates.MethodsA. baumannii isolates (n = 107) from ICU (Intensive care unit) of local hospitals in Makkah were phenotypically and genotypically characterized. The identity and antibiotic susceptibility of A. baumannii strains were determined using the Vitek-2 system. The identified ESBL producers were further analyzed by PCR and sequencing followed by MLST typing. blaTEM, blaSHV, and the blaCTX-M-group genes 1, 2, 8, 9, and 25 were investigated. Furthermore, blaOXA51-like and blaOXA23-like genes were also examined in the carbapenem-resistant A. baumannii isolates.ResultsOur data indicated a high prevalence of A. baumannii ESBL producers among the collected strains. Of the 107 A. baumannii isolates, 94 % were found to be resistant to cefepime and ceftazidime, and aztreonam using the Vitek 2 system. The genes detected encoded TEM, OXA-51-like and OXA-23-like enzymes, and CTX-M-group proteins 1, 2, 8, 9, and 25. MLST typing identified eight sequence type (ST) groups. The most dominant STs were ST195 and ST557 and all of them belong to worldwide clonal complex (CC) 2.ConclusionsThis study has shown that there is a high prevalence of antimicrobial resistance in A. baumannii. The diversity of STs may suggest that new ESBL strains are constantly emerging. The molecular diversity of the ESBL genes in A. baumannii may have contributed to the increased antimicrobial resistance among all isolates.

Physician's Satisfaction from Laboratory Services in Maternity and Children Hospital in Makkah

Physicians are primary customers of laboratory services and their perception of the provided services is considered an important measure of quality assurance. This study investigates the physicians’ satisfaction of laboratories’ services, in Maternity and Children Hospital in Makkah, to identify strength and possible limitations, which might inform the development plans for more efficient services.

Vitamin D Supplementation Practices in Pregnancy and During Infancy and Other Behaviors Related To Vitamin D Status among a Sample of Muslim Women in Ireland and Saudi Arabia

Objectives (background): Requirement for Vitamin D is high at particular stages of the lifecycle especially during pregnancy and infancy. Severe vitamin D deficiency during pregnancy may increase the risk of rickets in childhood. While policies exist in Ireland regarding supplementation of Vitamin D in either pregnancy or infancy, no policy recommendation exists in Saudi Arabia. The main aim of this study was to identify attitudes towards Vitamin D supplementation as well as its prevalence in pregnancy and infancy among Muslim mothers living in Ireland and in Saudi Arabia. Methods: A quantitative cross-sectional survey consisting of 121 Muslim mothers living in Saudi Arabia and 77 Muslim women living in Ireland. Recruitment of mothers took place in three hospitals in Makkah (Saudi Arabia Al-Noor Hospital, Hera'a Hospital and Maternity and Children's Hospital) and a religious Centre in Ireland between June and September 2012. Results: Only 28.6% of the Irish and 7.4% of the Saudi mothers had taken vitamin D supplements during their pregnancy. While 62.3% of the Muslim mothers in Ireland and 37.2% in Saudi Arabia were aware of the recommendation to give a daily vitamin D supplements to their infants until they were one year of age just 49.4% living in Ireland and 13.2% from Saudi Arabia did so. While a majority of mothers living in Ireland and Saudi Arabia were spending &gt; 30 minutes a day outside, clothing that completely cover the body was worn by the entire sample, sunscreen was used by 44.2% in Ireland and 53.7% in Saudi Arabia. Conclusion: Poor vitamin D supplementation practices are evident among Muslim mothers and infants both in Ireland and Saudi Arabia. To improve this situation, mothers should be educated about the importance of vitamin D during pregnancy and infancy.

Retrospective observational study examining indications for hospitalisation among haemodialysis patients at one of the Ministry of Health Hospitals in Makkah, Saudi Arabia.

SummaryObjectivesTo examine the indications for hospitalisations among haemodialysis patients.DesignA retrospective observational study.SettingAlnoor Kidney Centre in Al Noor Specialist Hospital, Makkah City, Saudi Arabia, which is a Ministry of Health hospital.ParticipantsParticipants were prevalent patients with end-stage renal disease on regular haemodialysis in 2011, who had received haemodialysis for more than three months. Each patient was followed up retrospectively, from the first date of initiating haemodialysis to the end of 2011.Main outcome measures(i) The primary reasons for hospital admissions and (ii) risk factors that increase the number of hospital admissions and which increase length of stay in hospital.ResultsThe primary reasons for hospital admissions associated with increases in the length of stay in hospital were diseases of the circulatory system (which increased hospital bed days by 70%; 95% CI: 11–161%; p value = 0.01 compared to all other reasons). The risk factors that increased the number of hospital admissions per patient-year at risk were increasing age (incidence rate ratio [IRR] = 1.02 per 1 year of age; 95% CI: 1.01–1.03; p value = < 0.0001); receiving haemodialysis through a catheter compared to arteriovenous fistula (IRR = 2.55; 95% CI: 1.14–4.97; p value = 0.001) and diabetes as a cause of renal disease compared to hypertension (IRR = 1.84; 95% CI: 1.29–2.63; p value = 0.001).ConclusionIndications for hospitalisation and consequences of practices related to hospitalisation for haemodialysis patients should be studied in further research to provide a comprehensive evidence-based management policy for haemodialysis patients in Saudi Arabia.

Detection of community-acquired methicillin-resistant Staphylococcus aureus by polymerase chain reaction

Methicillin-resistant Staphylococcus aureus (MRSA) is considered to have emerged from S . aureus through the acquisition of staphylococcal cassette chromosome mec (SCC mec ), which carries the mec A gene for methicillin resistance. Community-acquired Staphylococcus aureus (CA-MRSA) strains carry one of SCC mec types (IV or V). In addition they carry Panton-Valentine leukocidin (PVL) gene. The aim of this study was to evaluate the prevalence of CA-MRSA in Makkah hospitals by detection mec A, SCC mec types (IV and V) and PVL genes. One hundred bacterial isolates were confirmed to carry mec A gene. CA-MRSA was detected in 44% of these MRSA isolates, 30% were SCC mec type IV; 14% were SCC mec type V and 21% were harbored the PVL gene. Molecular methods are useful for diagnosis and typing of MRSA pathogens. CA-MRSA was found to be high in Makkah hospitals and hence the infection-control guidelines for of CA-MRSA are necessary to be improved.

Oxidized low density lipoprotein and total antioxidant capacity in type-2 diabetic and impaired glucose tolerance Saudi men.

BackgroundOxidative modification of low density lipoproteins (LDL) convert these native particles into pathogenic, immunogenic and atherogenic particles. Factors enhance LDL oxidation are poorly understood, especially in conditions of hyperglycemia. The present study was conducted to investigate which metabolic conditions are associated with the promotion of LDL oxidation in different glycemic situations.MethodsAdult male participants (274) were selected from patients admitted to the outpatient department of Diabetes Center in Al-Noor Specialized Hospital in Makkah and other citizens and residents in the city. The studied group was classified into three sub-groups: Group-I: control group of non-diabetic normal subjects, Group-II: subjects with impaired glucose tolerance (IGT) and Group-III: cases of type-2 diabetes mellitus (DM). Measurement of fasting blood glucose, 2 hour post-prandial blood glucose, glycosylated hemoglobin (HbA1c), triglycerides, serum cholesterol, HDL-cholesterol, LDL-cholesterol, ox-LDL, Total Antoxidant capacity (TAC) and Malondialdehyde (MDA) were performed. The obtained results were statistically analyzed.ResultsOxidation of native LDL increase nearly two folds in Type-2 DM group compared to controls. There is also significant increase in Ox-LDL of IGT group compared to controls. The correlation between Ox-LDL concentration and HbA1c in the whole population of the study confirms the increased Ox-LDL in subjects with hyperglycemia. A negative correlation exists between the concentration of Ox-LDL and total antioxidant capacity (TAC) in each studied group and in the whole population of the study as well. A positive correlation also exists between Ox-LDL concentrations and LDL values, more clear in controls and Type-2 DM, while this correlation was not significant in IGT group. The ratio of LDL oxidation as expressed by ox-LDL/LDL was increased in IGT group compared to control. More significant increase was observed in type-2 DM group.ConclusionWe concluded that the concentration of Ox-LDL increased in subjects with type-2 DM and IGT compared to controls. Moreover, oxidation of native LDL was associated with low levels of TAC and positively correlated with LDL levels, total cholesterol, HbA1c, body mass index (BMI) and increased age.

Prevalence and antibiotic susceptibility of methicillin-resistant Staphylococcus aureus isolated in Makkah hospitals

Article History This study aimed to report the frequency of MRSA among S. aureus isolates from patients in Makkah hospitals in Saudi Arabia and described the antimicrobial resistance profile of the MRSA isolates. 206 non-duplicated S. aureus clinical isolates were identified in the five main tertiary care hospitals in Makkah with standard microbiological methods. MRSA wer identified by Oxoid penicillin binding protein (PBP2') latex agglutination test, and confirmed by the oxacillin-salt agar-screening test. The antimicrobial susceptibility of all MRSA isolates were assessed using a VITEK 2 Compact 15 identification system. MRSA was 55.3% and most frequently isolated from the intensive care unit 37%. Of the patients infected with MRSA, the majority were men 60%, and 25% were over 60 years old. Of the MRSA strains isolated, 41% were from skin and wound swabs. The resistance rates among MRSA isolates for penicillin G, oxacillin, and vancomycin were 100%, 100%, and 0.9%, respectively. Our results indicated that the prevalence of MRSA in Makkah hospitals was generally high. vancomycin, teicoplanin, and the oxazolidinone linezolid were considered the drugs of choice for the treatment of MRSA infections.

Molecular characterization of methicillin-resistant Staphylococcus aureus isolated from tertiary care hospitals.

Methicillin-resistant S. aureus (MRSA) tends to be resistant to multiple antibiotics. Methicillin resistance is conferred by the acquisition of the mecA gene, which is carried by a mobile genetic element called the staphylococcal cassette chromosome mec (SCCmec). There are five major types of SCCmec elements (I-V). The majority of hospital-acquired MRSA (HA-MRSA) strains carry SCCmec types I, II, or III, whereas community-acquired MRSA (CA-MRSA) strains carry SCCmec types IV or V. In addition, Panton-Valentine Leucocidin (PVL) is a gene encoding a powerful cytotoxin that is strongly associated with CA-MRSA strains. The present study was aimed to identify the types of SCCmec and PVL genes among clinical MRSA isolates. This study was conducted in 5 tertiary care hospitals in Makkah city from March to September of 2012. A total of 206 S. aureus clinical isolates were analysed using standard microbiological methods. Multiplex PCR was performed on genomic DNA from MRSA isolates in order to identify the types of SCCmec. In addition, PCR was performed to detect the PVL gene among the isolates. Of the 206 S. aureus isolates, 114 (55.3%) were MRSA, and 100 of the MRSA isolates carried the mecA gene. RESULTS from SCCmec typing revealed that 3% were type I; 9% were type II; 47% were type III, and 29% were type IV. Nineteen per cent of the isolates harboured the PVL gene. Furthermore, there was a statistically significant correlation between the presence of the PVL gene and SCCmec type IV. The virulence of MRSA strains is increasing in both hospital and community settings in Makkah, highlighting the importance of their rapid identification in order to appropriately control infection.

Predictors of Death and Prolonged Hospital Length of Stay in Dengue Fever Patients Admitted to a Tertiary Hospital in Makkah.

Background and study aim: Dengue fever is one of the commonest viral infections in tropical and subtropical areas and its main burden is related to patient's mortality and cost of hospital admission. Our aim was to study dengue fever patients admitted to a tertiary hospital as regards the predictors of patient's death and prolonged hospital length of stay (HLOS). Patients and methods:This study included 123 patients. They were investigated for demographic, clinical and laboratory data that could predict the mortality and prolonged HLOS cases. Results : Ninety one patients were males (74%) and average age was 30.6 ± 13.8 years. 119 patients (96.7%) improved and 4 patients (3.3%) died in the hospital. Out of the 119 patients, 38 patients (30.9%) were discharged after 5 days. Statistically significant predictors of prolonged HLOS (> 5 days) were leucopenia, INR > 1.25 and Creatine Kinase (CK) serum level > 488 IU/dl. Predictors of patient's death were male, non Saudi patients, age > 41.5 years, and complicated case (ICU admission , CNS hemorrhage and renal and/or liver failure). On multivariate logistic regression analysis; the laboratory independent predictors of death were AST > 610 IU/dl, ALT > 150 IU/dl, PT > 16.65 sec and INR > 1.4. Conclusion : In a tertiary hospital in Makkah, the mortality rate of dengue fever patients was 3.3%.Predictors of patient's death were old age, male, non-Saudi patients, ICU admission, CNS hemorrhage, renal and liver failure and on multivariate logistic regression analysis, laboratory predictors were high serum levels of AST, ALT, PT and INR. About 31% of dengue fever patients needed hospital admission for >5 days and the statistically significant predictors were leucopenia, high INR and high CK serum levels.

Urinary Tract Infections among Pregnant Women in Makkah, Saudi Arabia

Urinary tract infection represents a serious health problem in pregnant women. Scarce information is available about the profile of urinary tract infections among pregnant women in Makkah, KSA. The aim of the current study was to study the prevalence of UTI among pregnant women in Makkah, KSA and to investigate the most frequent causative agents and drug resistance profiles associated with such infections. A total of 200 pregnant women that visited maternity and children hospital in makkah were investigated. Personal data as well as medical history were collected using a well structured questionnaire. Midstream clean catch urine samples for urinalysis, and urine culture were collected from all investigated cases. The results revealed that 20% of investigated pregnant women were positive for UTI (12% with symptomatic UTI and 8% were asymptomatic). Escherichia coli was the most frequently isolated bacterial agent (25%) from both symptomatic and asymptomatic bacteriuria. Amoxicillin, cefoxitin, celtaxidime, fusidic acid, norfloxacin, ofloxzcin and penicillin showed the least resistance frequency (2.6%). In conclusion, high rate of UTI infection (20%) was recorded among pregnant women with E. coli being the most frequently encountered causative agent. Although symptoms are good markers of UTI during pregnancy, special care has to be directed towards asymptomatic cases. Finally, Amoxicillin, cefoxitin, celtaxidime, norflaoacin, penicillin and fusidic acid are the most useful antibiotics for treatment of UTI as they were able to inhibit most of the currently isolated UTI pathogens.

Attitude and Awareness of Adverse Drug Reaction Reporting by Health Professionals in Seven Hospitals in the Holy City of Makkah, Kingdom of Saudi Arabia

Introduction: The increasing prevalence of Adverse Drug Reaction (ADR) has been reported by many countries and to develop a good ADR reporting system is the need of present time. Aim and objective: To assess attitude and awareness towards ADR reporting and factors that influences their reporting by health professionals. Materials and method: The present cross-sectional study was conducted in seven hospitals in Makkah. All the health professionals were invited to participate in the study. A prescribed questioners was used to collect basic information, professional information and knowledge about ADR reporting system. Results and conclusion: It was observed that most of the professionals were aware of ADR. They were having positive attitude to report ADRs. But major factor found as obstacle in ADR reporting were lack of training, non availability of forms, insufficient clinical knowledge and fear to report ADR.

Analysis of Factors Affecting the Satisfaction Levels of Patients Toward Food Services at General Hospitals in Makkah, Saudi Arabia

Previous studies showed that hospital food services remain to be a widespread problem all over the world. This study was conducted to determine the factors affecting satisfaction level of patients with food services in a sample of general hospitals in Makkah, Saudi Arabia. A cross sectional study was carried out in four general hospitals including 250 patients. Interview questionnaire was used for measuring satisfaction of the patients with food and food services. Results showed that (78.8%) of patients were satisfied overall with quality of food services in hospitals. Positive correlation was detected between the overall satisfaction level and the different aspects related to food and food services, the first three variables that had the strongest correlation with overall satisfaction were the taste of foods, being served with the favourite food and food appearance. Logistic regression analysis revealed that low monthly income, taste and temperature of food, attitude of staff serving food, and absence of disturbance inside, and outside the room were associated with satisfaction with hospital food and food services (p < 0.05) .Increasing the quality of foods and hospital food services increases the level of overall satisfaction with foods and food services. Ongoing education and communication with patients and dieticians is important in improving satisfaction with foodservice.

Frequency and antibiotic susceptibility of gram-positive bacteria in Makkah hospitals

BACKGROUND AND OBJECTIVE:Gram-positive bacteria are important nosocomial pathogens. The objective of this study was to estimate the frequencies and resistance rates of gram-positive pathogens isolated from hospitals in Makkah, Saudi Arabia.DESIGN AND SETTING:Prospective study at three Makkah hospitals from May 2008 to April 2009.PATIENTS AND METHODS:Clinical isolates were collected and demographic and laboratory data were recorded. Standard microbiological methods were used to identify the organisms and test for antimicrobial susceptibility. The results were interpreted according to the Clinical Laboratory Standards Institute (CLSI) guidelines.RESULTS:Clinical isolates were collected from 1087 patients. Gram-positive pathogens infected all age groups, but had no gender predominance. Staphylococcus aureus was the most common cause of wound infection and accounted for more than half of the clinical isolates (688 cases). Coagulase-negative staphylococcus (CONS) was a common isolate from blood cultures. Wounds were the most common site of infection (37.6%). Enterococcus spp. and Streptococcus agalactiae were the second most common bacteria (26%). The resistance rates of S aureus and CONS isolates were 39.4% and 82.4% for oxacillin, respectively. Among the streptococci, the resistance rates of Streptococcus pneumoniae were 21.1% and 16.7% for ampicillin and erythromycin, respectively.CONCLUSIONS:S aureus infections were found to be very common in the Makkah hospitals. Infection prevention, control measures and continuous monitoring for antibiotic susceptibility are necessary to reduce these and other nosocomial infections.

Is There a Place for Conservative Treatment of Acute Appendicitis?

Acute appendicitis is the most common acute surgical condition of the abdomen. The diagnosis of acute appendicitis continues to present clinicians with problems despite the advances in the investigating technology. This retrospective study aims to review appendiceal histopathological records in a district hospital in Makkah in 2007. The study was based on all appendices removed during emergency appendectomies to identify the proportion of normal and mildly inflamed appendices, in addition to their sex ratio, so that a prospective study can be carried out with conservative treatment with antibiotics, if justified. The records were divided into negative, mild and severely inflamed or perforated appendix. The number of the operations was 405, with nearly equal male and female ratio. The ratio of normal appendix was 24.2%, mild appendicitis was 26.4%, and severe appendicitis was 49.4%. Over 50% of all emergency appendectomies were performed on normal or mildly inflamed appendix, which rises to over 60% in females alone. The number of the males with severe appendicitis is nearly 50% more than that of the females. Patients, especially females, with normal or mildly inflamed appendix, if identified before surgery, may benefit from conservative treatment with antibiotics.

Dermatologic challenges of pilgrimage

Hajj is 1 of the 5 pillars of Islam. The Kingdom of Saudi Arabia has been privileged to host this event, which brings close to 2 million pilgrims from all over the world every year. During this holy ritual, the Muslims gather in Makkah before starting the journey. Recorded temperatures during the Hajj time is in the range between 37°C and 45°C. Overcrowding and the hot climate subject the pilgrims to environmental and health hazards. Dermatologic conditions, whether exacerbations of preexisting disease or the occurrence of new ones, account for 4.5% to 5.5% of all diseases seen during the 3-week periods of the Hajj. An overview of the mission of Hajj will be presented with an in-depth systematic review of dermatologic diseases seen at local hospitals in Makkah. Because the skin is the largest body organ and is the frontier defense for many environmental challenges, skin problems during the Hajj journey are not uncommon. The degree of heat and humidity may lead to exacerbation of preexisting cutaneous diseases or the occurrence of new ones. Overcrowding and poor hygiene also contribute to a myriad of infections: viral, bacterial, fungal, and/or parasitic. Skin diseases during Hajj can be divided into 2 broad categories, infectious and non–infectious. Unfortunately, despite the magnitude of Hajj and its existence for centuries, only a few reports and studies have been published about skin diseases. Preventative measures such as sunscreens, umbrellas, and protective footwear should be encouraged. The spread of cutaneous infections (fungal, viral, and bacterial) may be reduced with proper pretravel counseling and use of proper therapy.