Heat-related illnesses in a mass gathering event and the necessity for newer diagnostic criteria: a field study.

Heat-related illnesses (HRIs), mainly heat exhaustion (HE) and heat stroke (HS), are characterized by an elevation of core body temperature. In this study, we aimed to explore the HRIs' types and patient characteristics among a sample taken from various representative in-field points in the Hajj season. A cross-sectional study was conducted in 2018 at 80 data collection points distributed in the field. Data related to demographics, features and risk factors were collected and analyzed from all encountered cases with suspected HRIs. Moreover, we developed a diagnostic tree for HRIs by using the XGBoost model. Out of the 1200 persons encountered during the study period, 231 fulfilled the criteria of HRIs spectrum and were included in this study. Around 6% had HS and 20% had HE. All HS cases (100%) were from outside of Saudi Arabia as compared with 72.5% diagnosed with HE (27.5% were from Saudi Arabia). In addition, 16% were considered as heat-induced muscle spasms, and 7% had limb heat edema. Additionally, most of HRIs cases were reported between 11 am and 1 pm. The HRIs diagnostic tree model gave a diagnostic accuracy of 93.6%. This study highlights the magnitude of HRIs among pilgrims in Hajj and provides a diagnostic tree that can aid in the risk stratification and diagnosis of these patients. We advise the implementation of more educational campaigns to pilgrims regarding preventable measures especially for the vulnerable groups (e.g. from outside Saudi Arabia, those with comorbidities and light-skinned people).

Frequency of Post-operative Surgical Site Infections in a Tertiary Care Hospital in Abbottabad, Pakistan.

Background Any infection occurring in a wound after a surgical procedure is called a post-operative surgical wound infection. Surgical wound infection is a type of nosocomial infection that is acquired in hospitals when a person is admitted for reasons other than the infection. Surgical site infections (SSIs) are the second most common nosocomial (hospital-acquired) infections after urinary tract infections. SSIs contribute to a significant rate of morbidity and mortality in patients and has become a major public health problem worldwide. The increase in antibiotic resistance associated with SSIs has also become a therapeutic challenge for physicians worldwide. Methods This cross-sectional study was carried out among the patients admitted in various surgical wards of the Ayub Teaching Hospital. A total of 95 patients were enrolled for the study using a non-probability convenient sampling technique. Data were collected using a structured questionnaire by students carrying out the research for a time period of one month. SSIs were assessed by: 1. Pus or purulent discharge from the wound along with pain, 2. Any two cardinal signs of inflammation, and 3. Diagnosis of SSI by the surgeon. Results The mean age of the patients was 35.73 ± 19.73 years. SSI rate was found to be 33.68% with 32 patients developing SSIs out of 95 patients. The rate of SSIs was greater in older patients with four (44.4%) out of nine patients above 60 years developing SSIs. Patients belonging to urban areas had a higher incidence rate (52.77%) of SSIs as compared to rural areas (32.20%). The rate of SSIs in patients operated with an elective surgical plan was greater (37.93%) as compared to patients operated with an emergency surgical plan (27.77%). Patients who were obese were more prone to SSIs with seven (36.8%) patients developing SSIs out of 19. Surgeries performed by trainee medical officers had a greater rate of SSIs with 24 (35.3%) patients developing SSIs out of 68 patients. Three (66.66%) out of four patients with diabetes and 18 (40.9%) out of 44 patients with anemia developed SSIs. Conclusion This study concluded that the incidence rate of SSIs was high in patients admitted in Ayub Teaching Hospital. Major risk factors identified were co-morbidities, old age, obesity, duration of surgery, major surgeries, and anemia. Steps should be taken to decrease SSIs in these high-risk groups.