Background: Major intercontinental outbreaks of invasive meningococcal disease associated with the Hajj occurred in 1987, 2000, and 2001. Mandatory meningococcal vaccination for all pilgrims against serogroups A and C and, subsequently, A, C, W, and Y controlled the epidemics. Overseas pilgrims show excellent adherence to the policy; however, vaccine uptake among domestic pilgrims is suboptimal. This survey aimed to evaluate meningococcal vaccine uptake among Hajj pilgrims and to identify key factors affecting this. Methods: An anonymous cross-sectional survey was conducted among pilgrims in Greater Makkah during the Hajj in 2017-2018. Data on socio-demographic characteristics, vaccination status, cost of vaccination, and reasons behind non-receipt of the vaccine were collected. Results: A total of 509 respondents aged 13 to 82 (median 33.8) years participated in the survey: 86% male, 85% domestic pilgrims. Only 389/476 (81.7%) confirmed their meningococcal vaccination status; 64 individuals (13.4%), all domestic pilgrims, did not receive the vaccine, and 23 (4.8%) were unsure. Among overseas pilgrims, 93.5% certainly received the vaccine (6.5% were unsure) compared to 80.9% of domestic pilgrims (p < 0.01). Being employed and having a tertiary qualification were significant predictors of vaccination adherence (odds ratio (OR) = 2.2, 95% confidence interval (CI) = 1.3-3.8, p < 0.01; and OR = 1.7, CI = 1-2.5, p < 0.05, respectively). Those who obtained pre-Hajj health advice were more than three times as likely to be vaccinated than those who did not (OR = 3.3, CI = 1.9-5.9, p < 0.001). Lack of awareness (63.2%, 36/57) and lack of time (15.8%, 9/57) were the most common reasons reported for non-receipt of vaccine. Conclusion: Many domestic pilgrims missed the compulsory meningococcal vaccine; in this regard, lack of awareness is a key barrier. Being an overseas pilgrim (or living at a distance from Makkah), receipt of pre-Hajj health advice, and employment were predictors of greater compliance with the vaccination policy. Opportunities remain to reduce the policy-practice gap among domestic pilgrims. Author Contributions: Conceptualization, G.R.B., T.A., H.A., and H.R.; data curation, A.-M.B.; formal analysis, A.-M.B. and H.R.; project administration, H.R.; supervision, A.K., R.B., and H.R.; validation, A.-M.B., F.A., W.F., Trop. Med. Infect. Dis. 2019, 4, 127 11 of 13 and A.A.; visualization, A.-M.B.; writing-original draft, A.-M.B., F.A., W.F., A.A., and A.K.; writing-review and editing

IntroductionLeft ventricular dysfunction (LVD) is characterized as left ventricular ejection fraction (EF) below half of the systolic capacity of the left ventricle. Patients on hemodialysis have higher risk of developing LVD than the general population. Our aim was to assess hospitalization rate and outcomes in hemodialysis patients with LVD.Patients and methodsAll patients ≥18 years old, who started hemodialysis therapy at King Abdulaziz University Hospital between January 2011 and December 2011, were identified using medical records of hemodialysis unit. Patients were then divided into three groups, according to their EF results prior to the initiation of hemodialysis, as patients with EF <40%, EF between 40% and 49%, and EF ≥50%. Patients were then followed for 5 years by reviewing their hospital records to assess their outcomes, hospital admissions, and length of hospital stay.ResultsAnalysis included 333 patients. Patients with EF <40% were 40, 36 patients with EF 40%–49%, and 257 patients had an EF >50%. Patients with EF <50% were significantly older than patients with EF >50% (P=0.002). Diabetes mellitus and hypertension were more prevalent in patients with EF <40% and EF 40%–49% when compared with patients with EF >50% (P<0.001, P=0.002). The average length of stay between the three groups was significantly different (P=0.007). Intensive care unit admissions were significantly different when comparing the three groups (P=0.013) and was found to be an independent risk factor for mortality in our patients. Half of the patients with EF <40% and 44% of patients with EF of 40%–49% died compared with only 27% of patients with EF >50% (P=0.002). However, Kaplan–Meier analysis showed no significant difference in the survival time among the three groups (P=0.845).ConclusionMortality and morbidity increased in patients with LVD on hemodialysis compared with patients with normal EF.

A vast majority of open surgical repair of incisional hernias are achieved using a prosthetic mesh. Even though it is a tensionless repair, it is still associated with early or late complications such as mesh infection, surgical site infection, chronic pain, seroma, hematoma, mesh shrinkage, etc. The recurrence rate following mesh repair is still as high as approximately 32 % over a 10year follow-up period. 5 A number of factors can influence these complication rates, comprising the position and site ABSTRACT From the patient's perspective, a ventral hernia can cause pain, adversely affect function, increase size, cosmetically distort the abdomen, and incarcerate/strangulate abdominal contents. The only known cure for a ventral hernia is surgical repair. The purpose of the current analysis was to review the published randomized controlled trials (RCTs) of the surgical care of ventral hernia. We conducted this meta-analysis using a comprehensive search of EMBASE, MEDLINE, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials till 01 March 2018 for randomized controlled trials on the use of mesh reinforcement in abdominal wall hernia repair. 15 studies met the search criteria, laparoscopic repair (OR 0.59; 95% CI 0.02-6.71) had the highest probability of having the lowest rate of surgical site infection. Among open mesh repair techniques, sublay repair (OR 1.41; 95% CI 0.01-5.99) had the highest probability of being the best treatment. Among patients experiencing ventral hernia repair, mesh reinforcement ought to be used regularly when there is no infection. Sublay mesh might outcome in fewer reappearances and surgical site infections. The quality of evidence to support these recommendations is moderate to high.