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ObjectiveTo assess magnitude of diabetic ketoacidosis (DKA) among type-1 diabetics and to identify associated risk factors.MethodsA cross-sectional study was conducted among 236 type-1 diabetics in Makkah Al-Mukarramah City, Saudi Arabia.ResultsAmong participants, 59.3% were males, 44.1% were diabetic for more than 5 years, while 70.8% reported past history of DKA. The main causes of DKA were “first presentation of the disease” (40.9%), and “discontinued treatment” (37%). The HbA1c among 53.6% was above 9%. Almost all cases who experienced DKA were hospitalised (98.8%). Out of them, 9 (5.4%) suffered complications. Female patients were more likely to suffer from episodes of DKA than males (76% and 68.3%, respectively). Most patients whose parents’ highest education was primary level had DKA more frequently than those whose parents’ had postgraduate education. Patients with unemployed fathers had significantly higher frequency of DKA (p=0.004). Ketoacidosis was significantly more frequent among patients with parents’ consanguinity (p<0.001). Patients who had their current HbA1c level exceeding 9% had positive history of DKA compared to those with HbA1c level ≤7% (87.9% and 28.6%, respectively, p<0.001).ConclusionMost type-1 diabetics experience DKA, mainly with their first presentation of disease or due to discontinuation of treatment. DKA tends to occur more frequently among female patients, those with less educated parents or when their parents are relatives.ADVANCES IN KNOWLEDGEThis study rang a warning bell towards parents’ consanguinity among type-1 diabetics as a risk factor for diabetic ketoacidosis.The current search revealed the lack of public’s awareness about type-1 diabetes and its complications as well as their low compliance towards its treatment, since diabetic ketoacidosis occurred mainly at the first presentation of the disease among diabetics, or due to treatment discontinuation.APPLICATION TO PATIENT CAREThis study indicated the importance of raising the public’s awareness regarding early symptoms of diabetes among their children so as to be ready to seek medical advice as early as possible before the occurrence of complications.Health education messages should be repeatedly broadcast via mass media explaining the hazards associated with consanguineous marriages.Health care providers should stress to diabetic patients and/or their caregivers the importance of compliance to treatment.

Objective: To assess magnitude of diabetic ketoacidosis (DKA) among type-1 diabetics and to identify associated risk factors. Methods: A cross-sectional study was conducted among 236 type-1 diabetics in Makkah Al-Mukarramah City, Saudi Arabia. Results: Among participants, 59.3% were males, 44.1% were diabetic for more than 5 years, while 70.8% reported past history of DKA. The main causes of DKA were gfirst presentation of the diseaseh (40.9%), and gdiscontinued treatmenth (37%). The HbA1c among 53.6% was above 9%. Almost all cases who experienced DKA were hospitalised (98.8%). Out of them, 9 (5.4%) suffered complications. Female patients were more likely to suffer from episodes of DKA than males (76% and 68.3%, respectively). Most patients whose parentsf highest education was primary level had DKA more frequently than those whose parentsf had postgraduate education. Patients with unemployed fathers had significantly higher frequency of DKA (p=0.004). Ketoacidosis was significantly more frequent among patients with parentsf consanguinity (p<0.001). Patients who had their current HbA1c level exceeding 9% had positive history of DKA compared to those with HbA1c level .7% (87.9% and 28.6%, respectively, p<0.001). Conclusion: Most type-1 diabetics experience DKA, mainly with their first presentation of disease or due to discontinuation of treatment. DKA tends to occur more frequently among female patients, those with less educated parents or when their parents are relatives. Key words: Type 1 diabetes, diabetic ketoacidosis, magnitude, risk factors.

Melasma, a commonly acquired hyperpigmentation skin condition, is usually treated with topical agents as the first line of management. This systematic review and meta-analysis aimed to assess the efficacy and safety of azelaic acid versus hydroquinone in treating melasma patients. We conducted a comprehensive search across four online databases (PubMed, Scopus, Web of Science, and Cochrane Library) from the time of their creation until May 28, 2023. We considered randomized controlled studies comparing hydroquinone with azelaic acid for the treatment of melasma patients. We used the Cochrane Risk of Bias tool 2 to evaluate the risk of bias. The mean difference (MD) for continuous variables and the risk ratio (RR) for categorical variables, with a 95% confidence interval (CI) were pooled. Six studies were included, with a total of 673 patients with melasma. The azelaic acid had a lower mean change in melasma area severity index (MASI) than the hydroquinone group [MD= -1.23, 95% CI (-2.05, -0.40), P=0.004]. No difference was observed regarding the improvement via the objective response scale, the reduction in pigmentation, or the adverse events reported. However, despite not being statistically significantly different, there was a trend towards having more good responses in the azelaic acid group. Azelaic acid may be better than hydroquinone in reducing melasma severity (measured by MASI). However, larger studies with long-term follow-up are needed to validate these findings.