Objective. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the main causative agents of nosocomial infections that has posed a major threat to those with compromised immune systems such as nursing home residents. The aim of this study was to determine the rates of MRSA strains and the types of Staphylococcal Cassette Chromosome mec (SCCmec)in nursing homes in Saudi Arabia. Methods. A total of 188 nasal swabs were collected from the residents and nursing staff in two nursing homes in Riyadh, Saudi Arabia. All MRSA isolates were tested for antimicrobial susceptibility and analyzed for mecA and SCCmec typing by multiplex PCR assay. Detection of the Panton–Valentine leukocidin (PVL) gene was also tested in all positive MRSA isolates by multiplex PCR using specific primers. Results. Among the 188 collected nasal swabs (105 males and 83 females), MRSA colonization rate was 9.04% (11 (5.85%) females and 6 (5.71%) males). About 47% of MRSA were multidrug resistant (MDR) as acquired resistance to beta-lactam, macrolide, and aminoglycoside antibiotics. However, all the MRSA isolates showed susceptibility to vancomycin, tigecycline, and linezolid. All the MRSA isolates (n = 17) were mecA-positive with the SCCmec IVc (n = 7, 41.18%) as the most common SCCmec type followed by SCCmec V (n = 5, 29.41%) and SCCmec IVa (n = 2, 11.76%). The remaining isolates (n = 3) were nontypeable (17.65%). In addition, the PVL toxin gene was only detected in four of the male samples. Conclusion. MRSA nasal colonization is a common incident among nursing home residents. The prevalence of community-associated (CA) MRSA (SCCmec IV and V) was more common than hospital-associated (HA) MRSA in our study samples. It is crucial to investigate such rate of incidence, which is a key tool in preventive medicine and would aid in determining health policy and predict emergent outbreaks.

An 18-year-old male was referred from a local hospital with history of progressive shortness of breath for six months. He also complained of a syncopal attack on exertion lasting for few seconds. The patient had no significant past medical history except mild intermittent bronchial asthma controlled on inhaled albuterol as required. He denied use of any medication and there was no family history of respiratory or cardiac illness. On examination, he was found to have regular heart rate of 90 beats per minute, respiratory rate of 22 breaths per minute, blood pressure of 117/74 mmHg and an oxygen saturation of 91% on room air. Cardiopulmonary examination revealed raised jugular venous pressure, positive left parasternal heave, loud pulmonary component of 2 nd heart sound, tricuspid regurgitation murmur, minimal basal crackled on chest auscultation and mild pedal edema. Abdominal examination showed soft, non-tender, lax abdomen with no organ enlargement and neurological examination was normal.Laboratory including complete blood count, liver and kidney functions were within normal range. Pro-B type natriuretic peptide was elevated at 654 pg/mL (normal <100 pg/mL). Screening for autoantibodies was negative.Chest X-ray (Figure 1) revealed enlarged pulmonary arteries and increased bronchovascular markings. ECG showed sinus tachycardia, right axis deviation and prominent P wave.A 2-dimensional transthoracic cardiac echocardiogram showed a severely dilated right ventricle, moderate tricuspid regurgitation with estimated systolic pulmonary artery pressure of 50 mmHg. Left ventricle was normal with preserved systolic function. Right heart catheterization result revealed mean pulmonary artery pressure >60 mmHg, Right atrial pressure 6 mmHg, pulmonary capillary wedge pressure 8 mmHg, pulmonary vascular resistance 13.78 Wood units and cardiac index 1.98 L/m/min.A computed tomographic angiogram (CTA) of chest (Figure 2) did not show any evidence of pulmonary embolism but there were dilated main pulmonary arteries, enlarged right atrium and ventricle, septal thickening with nodularity, centrilobular ground glass densities