We describe the clinical patterns and case-fatality rate associated with severe Rift Valley fever (RVF) in patients who were admitted to the Gizan regional referral hospital during an outbreak of RVF in Saudi Arabia from September through November 2000. A total of 165 consecutive patients (136 men and 29 women) were prospectively studied; all were identified according to a strict case definition, were confirmed to have RVF by serologic testing, and were treated according to a predetermined protocol. The major clinical characteristics of RVF included a high frequency of hepatocellular failure in 124 patients (75.2%), acute renal failure in 68 patients (41.2%), and hemorrhagic manifestations in 32 patients (19.4%). Sixteen patients had retinitis and 7 patients had meningoencephalitis as late complications in the course of the disease. A total of 56 patients (33.9%) died. Hepatorenal failure, shock, and severe anemia were major factors associated with patient death.

ObjectiveTo assess the dietary total and complex carbohydrate (CHO) contents in type-2 diabetes mellitus (T2DM) participants in India.SettingWe enrolled 796 participants in this cross-sectional, single-visit, multicentre, two-arm, single-country survey. Participants were enrolled from 10 specialty endocrinology/dialectology centres from five regions of India.ParticipantsA total of 796 participants (Asian) were enrolled in this study (385, T2DM and 409, non-T2DM). Key inclusion criteria—male or female ≥18 years, diagnosed with T2DM ≥12 months (T2DM), and not on any diet plan (non-T2DM).Study outcomePrimary outcome was to find out the percentage of total energy intake as simple and complex CHO from total CHO. Secondary outcomes were to find the differences in percentage of total energy intake as simple CHO, complex CHO, proteins and fats between T2DM and non-T2DM groups. The percentage of T2DM participants adhering to diet plan and showing glycaemic controls were also examined.ResultsThe mean (SD) of total calorie intake per day (Kcal) was 1547 (610, 95% CI 1486 to 1608) and 2132 (1892, 95% CI 1948 to 2316), respectively, for T2DM and non-T2DM groups. In the T2DM group (n=385), the mean (SD) percentage of total energy intake as total CHO, complex CHO and simple CHO was 64.1±8.3 (95% CI 63.3 to 64.9), 57.0±11.0 (95% CI 55.9 to 58.1) and 7.1±10.8 (95% CI 6.0 to 8.2), respectively. The mean (SD) percentage of complex CHO intake from total CHO was 89.5±15.3 (95% CI 88.0 to 91.1). The mean (SD) total protein/fat intake per day (g) was 57.1 (74.0)/37.2 (18.6) and 57.9 (27.2)/55.3 (98.2) in T2DM and non-T2DM groups, respectively.ConclusionsOur study shows that CHO constitutes 64.1% of total energy from diet in T2DM participants, higher than that recommended in India. However, our findings need to be confirmed in a larger epidemiological survey.Trial registration numberNCT01450592 & Clinical Trial Registry of India: CTRI/2012/02/002398.

Malaria remains a major problem in many parts of the world. Approximately 500 million people are affected annually, and about three million, mostly children, die of falciparum malaria each year. [1][2][3][4][5] In areas of endemic malaria, the most common clinical presentation is that of uncomplicated infection with prompt recovery after treatment.6,7 However, in nonimmune individuals, malaria may present in its most severe forms. 2,5,6,8 Despite a vigorous program of malaria control in the Kingdom of Saudi Arabia, the infection is still endemic in the southwestern area of the country.9 As a result of continued preventive measures, the epidemiology of the disease may be changing, and the proportion of nonimmune individuals may increase. Furthermore, the emergence of chloroquine-resistant malaria in the neighboring country of Yemen has a major implication for the Gizan population.2,4 The frequency and clinical outcome of severe malaria may provide useful, albeit indirect, information on the emergence of antimalarial drug resistance in this region. We describe the clinicopathologic profile and mortality in patients treated for severe malaria in King Fahad Central Hospital (KFCH), Gizan, Saudi Arabia. Materials and MethodsThe Gizan region is one of the 14 administrative provinces of Saudi Arabia. It is located on the Red Sea coast, about 1000 km southwest of Riyadh, and shares its border with Yemen to the east, and the Asir region to the north. The population of about one million is distributed mainly in the rural areas. All serious and complicated cases from the various general hospitals in the region are referred to the KFCH, which is the regional referral center. In addition, the emergency room is open 24 hours each day, allowing self-referral or presentation by those needing emergency care.The medical records of all cases of malaria admitted to the KFCH, from 1995 to 1997 (a three-year period), were analyzed. Malaria was diagnosed by the clinical presentation of fever, positive blood smear for asexual forms of Plasmodium falciparum, and response to antimalarial therapy. After a detailed history was obtained from either the patient or accompanying relatives, the patient was carefully examined. Thick and thin blood films were stained with Giemsa for the detection and characterization of malarial parasites. The parasite load was estimated to range from mild to severe on a scale of 1-4, corresponding approximately to <5%, 5%-10%, 10%-20%, and >20%, respectively. Additional investigations included the determination of hemoglobin level (Hb), white blood cell count (WBC), hematocrit, platelet count, reticulocyte count, mean corpuscular hemoglobin concentration, electrolytes, blood urea nitrogen (BUN), creatinine, blood glucose, bilirubin, aminotransferase, and lactic dehydrogenase in all the patients. Blood cultures, chest x-ray, abdominal ultrasound, urine and stool examination were done where indicated. Cerebrospinal fluid examination and CT scan of the brain were performed in some of the patients, as indicated clin...

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INTRODUCTION:Type 2 diabetes is a progressive disorder of β-cell dysfunction. Patients using oral therapy alone for it seldom achieve and maintain the recommended 7% HbA1c goal for glycemic control. However, the majority of patients with a longer duration of diabetes remain poorly controlled with oral agents, and use of insulin, which could improve glycemic control, is often long delayed and not aggressive enough. Glargine, a long-acting insulin analog with a more favourable 24-h time-action profile (no pronounced peak) than long-or intermediate-acting human insulin preparations, may be especially suited in this condition. AIMS: To compare the safety and efficacy of the long-acting analog insulin glargine and human premix insulin in patients with type 2 diabetes who were previously treated with oral hypoglycemic drugs alone but inadequately controlled. SETTINGS AND DESIGN: A total of 750 subjects with type 2 diabetes who were receiving oral hypoglycemic drugs for diabetes control were randomized to receive insulin glargine once daily (n = 370) or human premix insulin twice daily (n = 380) for 24 weeks in an open-label, tertiary centre study. Doses were adjusted systematically to obtain target fasting glucose < 100mg/dl. Outcomes included fasting blood sugar, HbA1c levels, change in weight and insulin dose from study start to end. STATISTICAL ANALYSIS: Qualitative variables were tested using Chi square test and p values were calculated between two groups. RESULTS: At the start of study, age range was 30-70 years, BMI was 26.48 +/-6.3 kg/m (2) , and HbA1c was 11.9 +/-3.1%(mean +/-SD) for both group. The mean change (means ± SD) in HbA1c from baseline to end point was similar in the insulin glargine group (−3.0 ± 1.68%) and the human premix insulin group (−2.89 ± 1.79%) (P value =0.3861). The symptomatic hypoglycemic episodes were greater with human premix insulin than with glargine (significance level 0.00002).Subjects in the insulin glargine group experienced less weight gain than those in the premix human insulin group (0.4 vs. 1.4 kg, P < 0.0001). CONCLUSIONS: In patients with type 2 diabetes, once-daily bedtime insulin glargine is as effective as twice-daily human premix insulin in improving and maintaining glycemia control. In addition, insulin glargine demonstrates a lower risk of symptomatic hypoglycemia and less weight gain compared with human premix insulin. The treatments were associated with similar reductions in fasting glucose levels and HbA1c levels.