Sensitive, resistant and multi-drug resistant Acinetobacter baumanii at Saudi Arabia hospital eastern region.

Since the Physicians start use of antibiotics long ago with un-notice drug resistance. However actual problem was recognized about 85 years ago. Antibiotic resistant and Multi-drug resistant bacterial strains are at rise throughout the world. It is physicians and researchers to take scientific research based appropriate action to overcome this ever-spreading problem. This study is designed to find out sensitive (S), resistant (R) and multi-drug resistant (MDR) Acinetobacter baumanii strain along with other isolates in the resident patients of Eastern Region of Saudi Arabia. Pseudomonas aeruginosa is excluded from other gram-negative organisms isolated from different sites as it will be dealt separately. This study is based in was retrospective observations designed to collect data of different stains of Acinetobacter baumanii with reference to their Sensitivity (S), Resistance (R), Multi-Drug Resistance (MDR) along with other Gram negative isolated from different sites (from 1st January 2004 to 31st December 2011) at King Abdulaziz Hospital located Eastern Region of Kingdom of Saudi Arabia (KSA). All necessary techniques were used to culture and perform sensitivity of these isolates. There were 4532 isolates out of which 3018 (67%) were from patients. Out of Acinetobacter baumanii infected were 906 (20%) while other 3626 (80%) isolates were miscellaneous. Numbers of patients or cases were 480 (53%) out of 906 isolates and numbers of patients or cases in other organisms were 2538 (70%) out of 3626 isolates. Acinetobacter baumanii infected patients 221 (46%) were male and 259 (54%) were female and the male and female ratio of 1:1.2. In other organisms this male female ratio was almost same. There was steady rise in number of patients and the hence the isolates from 2004 to 2011. Majority of the bacterial strains were isolated as single organism but some were isolated as double or triple or quadruple or more organisms from different sites. Sensitive, Resistant and Multi-Drug Resistant Acinetobacter baumanii have been isolated from different sites. The other Gram negative isolates included Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, Klebsiella oxytoca, Serratia marcescens and Stenotrophomonas maltophilia. A significant rise in R and MDR but there is rise in R and MDR Acinetobacter baumanii Strains has been interceded other isolates. It is important to adopt proper and sustainable policies and guideline regarding antibiotics prescription and used. We should also check our infection control practices in our hospital or healthcare settings. We should start antibiotics stewardship in our hospital in order to reducing or overcoming antibiotics Resistant (R) and Multi-Drug Resistant (MDR) strains prevalence.

Primary posterior mediastinum hydatid cyst.

Primary posterior mediastinal hydatid cyst is a serious health problem for the Mediterranean countries. We diagnosed a case of a 46-year-old female with a primary posterior mediastinum hydatid cyst on CT and MRI. It was provisionally identified as either a hydatid cyst or bronchogenic cyst or neuroenteric cyst. CT guided aspiration with 18 gauge needle confirmed as hydatid sand. This is very rare in this population but it should be kept in mind when one is looking at any cyst in the posterior mediastinum.

The significance of documenting clinical appearance of the uterine cervix in the cervical cytology form.

OBJECTIVE: To determine whether or not the Pap smear taker is reporting the clinical appearance of the cervix on the cytology request form, and if cytologist / smear taker are giving any importance to this information prior to issuing advice on subsequent follow-up. Finally, to evaluate the clinicians' response to normal Pap smear report in the absence of the clinical comment on the cervix. METHODS: A retrospective study, for a total of 1196 random smear results performed between 1999 and 2000 at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia with its relevant charts were evaluated. The samples were divided into 2 main groups. Group I, the Pap smears sent with the absence of clinical description of the cervix, and group II, was sent with the clinical description of the cervix. Cytologist follow up recommendations and the clinicians' response were evaluated. RESULTS: A total of 1196 Pap smears were reviewed. Of the total 510 (42.6%) smears represented group I. Vast majority 506/510 (99.2%) were reported to be normal. A 12 months follow up was given for 505/506 (99.8%) smears. Only 4/510 (0.8%) Pap smears were abnormal and relevant cytologist's recommendations were given. Clinicians reassessed the uterine cervix for only 7.7% of the patients in the group. A total of 686/1196 (57.4%) smears represented group II. The vast majority 630 (91.8%) were with normal cervical appearance, 627/630 (99.5%) had normal cytology and only 3/630 (0.5%) had significant intraepithelial lesion. Relevant recommendations were given by the cytologist and were accepted by clinicians. A total of 56/686 (8.2%) had abnormal cervical appearance and 45/56 (80.4%) had normal cytology. A 12 months follow up was recommended for all except 7/45 (15.6%). Clinicians have followed these recommendations for all except 5/45 (11.1%). Eleven out of 56 (19.6%) smears were abnormal, relevant recommendations were given by the cytologist and all were followed by the clinicians. CONCLUSION: High proportion of cervical smears request did not report clinical appearance of uterine cervix (42.6%). In patients whose cervical smear was reported abnormal (8.2%), 19.6% of them were found with significant intra-epithelial lesion. The clinical appearance of the cervix should be documented on the Pap smear request. Follow up recommendation for Pap smears carried out without clinical appearance description should be left to the clinician.