Symptoms and management of cow's milk allergy: perception and evidence.

Introduction: The diagnosis and management of cow's milk allergy (CMA) is a topic of debate and controversy. Our aim was to compare the opinions of expert groups from the Middle East (n = 14) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (n = 13). Methods: These Expert groups voted on statements that were developed by the ESPGHAN group and published in a recent position paper. The voting outcome was compared. Results: Overall, there was consensus amongst both groups of experts. Experts agreed that symptoms of crying, irritability and colic, as single manifestation, are not suggestive of CMA. They agreed that amino-acid based formula (AAF) should be reserved for severe cases (e.g., malnutrition and anaphylaxis) and that there is insufficient evidence to recommend a step-down approach. There was no unanimous consensus on the statement that a cow's milk based extensively hydrolysed formula (eHF) should be the first choice as a diagnostic elimination diet in mild/moderate cases. Although the statements regarding the role for hydrolysed rice formula as a diagnostic and therapeutic elimination diet were accepted, 3/27 disagreed. The votes regarding soy formula highlight the differences in opinion in the role of soy protein in CMA dietary treatment. Generally, soy-based formula is seldom available in the Middle-East region. All ESPGHAN experts agreed that there is insufficient evidence that the addition of probiotics, prebiotics and synbiotics increase the efficacy of elimination diets regarding CMA symptoms (despite other benefits such as decrease of infections and antibiotic intake), whereas 3/14 of the Middle East group thought there was sufficient evidence. Discussion: Differences in voting are related to geographical, cultural and other conditions, such as cost and availability. This emphasizes the need to develop region-specific guidelines considering social and cultural conditions, and to perform further research in this area.

Descriptive epidemiology and characteristics of confirmed cases of Middle East respiratory syndrome coronavirus infection in the Makkah Region of Saudi Arabia, March to June 2014.

BACKGROUND AND OBJECTIVES: Describe the epidemiology and characteristics of Middle East respiratory syndrome coronavirus (MERS-CoV), which are essential for control and treatment. METHODS: We conducted a retrospective review of all cases of MERS-CoV reported in four cities of the Makkah Region from March to June 2014. Exposure factors and comorbid conditions were analyzed using Epi Info. RESULTS: Analysis of the 261 cases revealed that the incidence peaked in mid-April 2014 and the fatality rate was 42%. Cough, fever, radiological evidence of pneumonia, and shortness of breath were identified as significant risk factors for a diagnosis of MER-CoV infection. Healthcare workers (HCWs) are at a higher risk of acquiring MERS-CoV than non-HCWs. Males in Jeddah are at higher risk due to greater outdoor exposure while females in Taif are at higher risk due to domestic caregiving. Filipino nurses are at highest risk among all HCWs. CONCLUSION: The findings indicate the need to screen all contacts of HCWs to improve MERS control and form public-private partnerships to investigate the true burden of MERS.

Prevalence of chronic venous insufficiency in the Saudi adult population.

OBJECTIVE: To estimate the prevalence of chronic venous insufficiency (CVI) in the Saudi adult population and to identify the association of CVI with possible risk factors. METHODS: Sixteen Primary Health Care (PHC) centers have been randomly selected in various districts of 3 major cities of Kingdom of Saudi Arabia, including Jeddah, Makkah and Dammam during the year 2001. Every Saudi patient, of both sexes and aged >18 years, visiting the selected PHC centres for any reason, was eligible. The study was conducted during 6 consecutive days. Patients' history, demographics and risk factors were recorded and clinical examination was performed in order to diagnose CVI according to the latest clinical severity, etiology or cause, anatomy, pathophysiology (CEAP) classification. RESULTS: A total of 2566 participants were recruited. Out of these, 2350 were included. Fifty-three percent of the included patients were females and 66% were from the Western region. The overall prevalence of CVI (from class 0 to 4) was 45.6% (95% confidence interval [CI] 43.6 - 47.6). Considering CVI with visible signs only (class 1 to 6), the prevalence was 38.3% (95% CI 36.6 - 40.2). It was found higher in female (49.6%) and in the Western region (43.0%). Chronic venous insufficiency was significantly associated with age, family history of CVI, prolonged standing occupation and the use of hormonal therapy. CONCLUSION: These data demonstrated a high prevalence of CVI in the Saudi population, which is higher than in Western countries, especially in the Western region. This is probably linked to the high frequency of risk factors in the Saudi population and to the current lifestyle.