The objective of this study was to assess the validity of the new dengue classification proposed by the World Health Organization (WHO) in 2009 and to develop pragmatic guidelines for case triage and management. This retrospective study involved 357 laboratory-confirmed cases of dengue infection diagnosed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia over a 4-year period from 2014 to 2017. The sensitivity of the new classification for identifying severe cases was limited (65%) but higher than the old one (30%). It had a higher sensitivity for identifying patients who needed advanced healthcare compared to the old one (72% versus 32%, respectively). We propose adding decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification. This modification improves sensitivity from 72% to 98% for identifying patients who need advanced healthcare without altering specificity (97%). It also improves sensitivity in predicting severe outcomes from 32% to 88%. In conclusion, the new classification had a low sensitivity for identifying patients needing advanced care and for predicting morbidity and mortality. We propose to include decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification to improve the sensitivity of predicting cases requiring advanced care.
Dengue fever, the most prevalent arthropod-borne viral disease in human, has been conventionally classified into four main categories: non-classical, classical, dengue hemorrhagic fever, and dengue shock syndrome. Several studies reported lack of correlation between the categories of the conventional classification and the disease severity. As a consequence, the World Health organization proposed in 2008 a new classification that divides dengue into two categories: non-severe and severe dengue; the non-severe dengue is further divided into two categories: dengue with warning signs and dengue without warning signs. In this retrospective study we reviewed 357 cases of dengue diagnosed in our institution over a 4-year period to assess the validity of the new dengue classification in order to develop pragmatic guidelines for case triage and management in the Emergency Departments. We found that the sensitivity of the new classification for identifying severe cases was limited even though it had a higher sensitivity for identifying patients who needed advanced healthcare compared to the old one. We propose adding decompensation of chronic diseases and low platelets-related bleeding to the category of severe dengue in the new classification. This modification dramatically improves the sensitivity for identifying patients who need advanced healthcare and the sensitivity to predict severe outcomes.4
Key Clinical MessageHypertension with Chronic kidney disease is often difficult to control medically. In such patients, nephrectomy can help to control blood pressure (BP). We describe a case of a 6-year-old boy with autosomal recessive polycystic kidney disease who showed a paradoxical increase in BP following bilateral nephrectomy.
AIMTo compare the effect of different treatment regimens (oral hypoglycemic agents [OHGs], insulin therapy, and combination of both) on glycemic control and other cardiometabolic risk factors in type 2 diabetes mellitus (T2DM) patients in Saudi.SUBJECTS AND METHODSPatients with T2DM, but no serious diabetic complications, were randomly recruited from the diabetes clinics at two large hospitals in Jeddah, Saudi Arabia, during June 2013 to July 2014. Only those without change in treatment modality for the last 18 months were included. Blood pressure and anthropometric measurements were measured. Treatment plan was recorded from the patients’ files. Fasting blood sample was obtained to measure glucose, HbA1c, and lipid profile.RESULTSA total of 197 patients were recruited; 41.1% were men and 58.9% were women. The mean (±SD) age was 58.5 ± 10.5 years. Most patients (60.7%) were on OHGs, 11.5% on insulin therapy, and 27.7% were using a combination of insulin and OHGs. The mean HbA1c was lower in patients using OHGs only, compared with means in those using insulin, or combined therapy in patients with disease duration of ≤10 years (P = 0.001) and also in those with a longer duration of the disease (P < 0.001). A lower mean diastolic and systolic blood pressure was found among patients on insulin alone (P < 0.01). No significant differences were found in lipid profiles among the groups.CONCLUSIONInsulin therapy, without adequate diabetes education, fails to control hyperglycemia adequately in Saudi T2DM patients. There is a challenge to find out reasons for poor control and the ways as to how to improve glycemic control in T2DM.
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