Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi Arabia / 医学前沿

Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012 as an important respiratory disease with high fatality rates of 40%-60%. Despite the increased number of cases over subsequent years, the number of pediatric cases remained low. A review of studies conducted from June 2012 to April 19, 2016 reported 31 pediatric MERS-CoV cases. In this paper, we present the clinical and laboratory features of seven patients with pediatric MERS. Five patients had no underlying medical illnesses, and three patients were asymptomatic. Of the seven cases, four (57%) patients sought medical advice within 1-7 days from the onset of symptoms. The three other patients (43%) were asymptomatic and were in contact with patients with confirmed diagnosis of MERS-CoV. The most common presenting symptoms were fever (57%), cough (14%), shortness of breath (14%), vomiting (28%), and diarrhea (28%). Two (28.6%) patients had platelet counts of < 150 × 10/L, and one patient had an underlying end-stage renal disease. The remaining patients presented with normal blood count, liver function, and urea and creatinine levels. The documented MERS-CoV Ct values were 32-38 for four of the seven cases. Two patients (28.6%) had abnormal chest radiographic findings of bilateral infiltration. One patient (14.3%) required ventilator support, and two patients (28.6%) required oxygen supplementation. All the seven patients were discharged without complications.

Trends of reported human cases of brucellosis, Kingdom of Saudi Arabia, 2004-2012

Human brucellosis is an important zoonotic disease and is especially concerning in the Kingdom of Saudi Arabia [KSA], where livestock importation is significant. We analyzed reported human brucellosis disease trends in KSA over time to help policymakers understand the magnitude of the disease and guide the design of prevention and control measures. By using data from the national registry from 2004 to 2012, we calculated the cumulative numbers by age group and months. Trends of incidence rates [IRs] by gender, nationality, and region were also calculated. We found that there was a greater number of cases [19,130] in the 15-44 years age group than in any other age group. The IRs significantly decreased from 22.9 in 2004 [95% confidence interval [CI] = 22.3, 23.5] to 12.5 in 2012 [95% CI = 12.1, 13]. Males had a significantly greater IR than females. Most cases were reported during spring and summer seasons. The IR of Saudi citizens was significantly greater than that of non-Saudis, but this difference reduced over time. The IRs of Al-Qassim, Aseer, and Hail were in the highest 25th percentile. Young, male Saudi citizens living in highly endemic areas were at greatest risk of acquiring brucellosis. We recommend vaccinating susceptible animals against brucellosis and increasing the public's awareness of preventive measures

Evaluation of home respiratory therapy delivered to patients in the Ministry of Health's Home Medical Program [HMP] and administered through the Madinah HMP Center, Kingdom of Saudi Arabia, 2013

This was an evaluation of home respiratory therapy [HRT] services administered through the Madinah Home Medical Program [MHMP] Center of the Ministry of Health [MoH], Kingdom of Saudi Arabia [KSA]. Using a retrospective design and descriptive analyses, we analyzed 83 patient records for the clinical care received, outcomes, and patient satisfaction. We also assessed a subset from an economic perspective. Demographically, 72% were >60 years of age, 80% were female, and 90% were Saudi. Asthma accounted for 34% of the diagnosed respiratory diseases, followed by chronic obstructive pulmonary disease [11%]. Most patients [71%] required two or three respiratory modalities: 94% used oxygen therapy and 14% were on mechanical ventilation. A full 90% of HMP patients expressed a high level of satisfaction with the HMP overall care, and 43% saw an improvement in their condition. The MHMP lowered healthcare costs for HRT-receiving patients by decreasing the frequency of emergency room [ER] and outpatient visits by 50.8% from 59 to 30 visits. HRT administered through the MHMP Center improved clinical outcomes and increased patient satisfaction while reducing hospital utilization and associated costs. A prospective study is recommended to assess HMP services in comparison with hospitalization

Cardiovascular risk profiles of adults with type-2 diabetes treated at urban hospitals in Riyadh, Saudi Arabia

Diabetes mellitus substantially increases cardiovascular disease [CVD] risk. Among Saudi Arabian citizens with diabetes, little is known about the prevalence and control of other CVD risk factors. We extracted data from medical records of a random selection of 422 patients seen between 2008 and 2012 at two diabetic clinics in Riyadh, Saudi Arabia. We calculated the proportion of patients who had additional CVD risk factors: obesity [body mass indexP 30 kg/m[2]], hypertension [BPP 140/90 mmHg], elevated cholesterol fractions, and multiple risk factors]. Further, we calculated the proportion of patients meeting the American Diabetes Association's recommended care targets for each risk factor. Of 422 patients [mean age, 52 years], half were women, 56% were obese, 45% had hypertension, and 77% had elevated LDL concentrations. In addition to diabetes, 70% had two or more CVD risk factors. Although 9%met both target HbA1c and BP values, only 3.5% had optimum HbA1c, BP, and lipid values. In Saudi Arabia's best diabetes clinics, most patients have poor control of their disease. This huge disease burden and related care gaps have important health and financial implications for the country

Evaluation of tuberculosis public health surveillance, Al-Madinah province, Kingdom of Saudi Arabia, 2012

The objective of the study is to evaluate the quality of the data, the sensitivity of the surveillance, and the completeness of identification and investigation of tuberculosis [TB] patient's contacts. The study covered the TB surveillance program in Al-Madinah province in 2011. First, we reviewed all the notifications, treatment cards, and register books, as well as monthly and quarterly reports, for completeness and accuracy of data. Then, we searched for the missed cases that were not reported. Finally, we reviewed all the patients' household contacts' reports to assess the degree of completion of identification and investigation. There were 444 cases detected during the study period; only 200 cases were reported. The sensitivity of the TB surveillance system was 45%. Among the 200 reported cases, the results revealed high completeness rates for demographic and disease data and low completeness rates for the test result fields. The contact identification and investigation showed that 34.4% of smear-positive cases' contacts were not identified. Only 67% of identified contacts were investigated. The review of hospital records and lab registers showed that 244 cases were not reported. In conclusion, the TB surveillance system has several areas that need improvement

Foot ailments during Hajj: a short report

A study of ailments of the feet in pilgrims of Hajj revealed that 31% of them suffered from blisters, and the prevalence was five times higher in females. The presence of comorbidity [diabetes, obesity and advanced age] warrants immediate attention to them to avoid serious complications

Factors associated with public awareness of the crown health program in the Al-Jouf region

A community-based intervention, the Crown Health Project [CHP], was developed by the Ministry of Health. It was implemented on a small-scale in Al-Jouf Region in Northern Kingdom of Saudi Arabia to assess its feasibility and effectiveness so that it can be scaled up. This study primarily aimed at investigating factors associated with the awareness of CHP in order to improve subsequent campaigns for the program in Al-Jouf and other regions. A secondary aim was to assess possible changes of public awareness during intensification of the awareness campaign between October 2011 and May 2012. A pre- and post-questionnaire cross-sectional approach was undertaken, and the intervention was an awareness campaign. Variables collected included demographic characteristics [e.g., age, gender, education, occupation, urban/rural residence] and CHP awareness [its existence, sources of knowledge about CHP, its goals and objectives, its target diseases, location of activities, participation in such activities]. Logistic regression was used to analyze the awareness of the program according to participant characteristics, with a time of the survey as a variable. Awareness of the program was found to be 11 times higher among postsurvey respondents than presurvey respondents. Respondents of the second survey were better at correctly identifying "health education" as the main goal of the CHP [odds ratio [OR], 4.1; 95% confidence interval [CI], 3.1-5.5], "noncommunicable diseases" as the main diseases targeted [OR, 4.8; 95% CI, 3.6-6.4] and "attention to health" as the purpose [OR, 6.0; 95% CI, 4.0-8.9]. The different activities of the CHP were successful in dramatically increasing awareness of the CHP program in Al-Jouf

Nocardia abscessus brain abscess in an immunocompetent host

Nocardia brain abscesses typically occur in immunocompromised patients. Most cases of nocardiosis are caused by the Nocardia asteroides complex and Nocardia brasiliensis. Here, we present a patient with a Nocardia abscessus brain abscess. The diagnosis was confirmed by DNA sequencing, and the organism was susceptible to linezolid, clarithromycin, ceftriaxone, imipenem, tobramycin, amikacin, minocycline and sulfamethoxazole. The patient was successfully treated medically in combination with surgical excision

Middle East respiratory syndrome novel corona [MERS-CoV] infection. Epidemiology and outcome update

Middle East respiratory syndrome coronavirus MERS-CoV is a newly emerging respiratory virus with a high case fatality rate among identified cases. The virus is thought to cause a severe disease in patients with underlying Co-morbidities. The identification of asymptomatic patients and mild cases among family and healthcare worker contacts of confirmed cases indicates a wider spectrum of clinical manifestation of the disease. The majority of patients presented with fever [98%], fever with cough [83%], and shortness of breath [72%]. Radiographic manifestations range from unilateral infiltrate [43%], to increased bronchovascular markings [17%], and diffuse reticulonodular pattern [4%]. Our understanding of the epidemiology and clinical presentation of the disease is increasing overtime. It is still not known what the source of the virus is and what the best treatment modality should be

Patterns of diseases and preventive measures among domestic hajjis from Central, Saudi Arabia [complete republication]

To identify the occurrence of upper respiratory tract infections [URTI], diarrheal diseases and trauma during the Hajj season, and the practice of some preventive measures by pilgrims. A cohort study during November and December 2009 among hajjis registered while visiting Primary Health Care Centers of Riyadh, Kingdom of Saudi Arabia to get mandatory meningococcal meningitis vaccination. On return from hajj, hajjis were contacted on telephone to collect information on occurrence of URTI and diarrhea along with other associated activities in Hajj. Out of 1507 hajjis, 54.7% developed symptoms; 97% reported upper respiratory tract symptoms, and 9.3% reported diarrheal symptoms. Those <40 years of age were more likely to develop an URTI. The incidence of diarrheal diseases or trauma was not statistically associated with age. No statistical difference for educational level was found for URTI or trauma, but there was a statistically significant difference for diarrheal diseases. There was no statistical difference for nationality in relation to diarrheal diseases and trauma, but there was a statistically significant difference for URTI. There was a statistically significant difference of URTI between those pilgrims who used the face mask most of the time and those who used it sometimes. Upper respiratory tract infections is a common health problem among studied domestic hajjis. Generally, there is room for improvement in the adoption of preventive measures by hajjis; and there is still limited information on the use of facemasks in spite of the fact that using it significantly decreases the risk for URTI