Fever of unknown origin: 98 cases from Saudi Arabia

Fever of unknown origin [FUO] is mainly secondary to infectious, neoplastic or inflammatory diseases. To increase the body of knowledge on this diagnosis in the region, we collected information on all patients admitted to our institution with FUO in a 13-year period. We conducted a retrospective chart review of all immunocompetent males and females aged 13 years and older admitted between January 1995 and June 2008 who fulfilled the criteria for FUO. Data collection included demographics, laboratory investigations, imaging studies, procedures and discharge diagnoses. For true FUO, we recorded the duration of follow-up and the outcome. The 98 patients who met the criteria included 44 males and 54 females with a mean [SD] age of 41.3 [18.5] years and range of 14 to 85 years. The most frequent diagnostic etiology was infectious in 32 [32.7%]. Seventeen [17.3%] patients were undiagnosed or had true FUO. Of 9 patients followed up, 8 recovered and 1 expired. The mean duration of follow-up was 20.6 months [range, 0-168 months]. Infectious diseases, especially TB, continue to be the leading etiology of FUO in our area. Our data did not identify any predictor of certain FUO diagnoses except for older age and neoplastic etiology. True FUO patients generally did well. Reporting local experience is important in guiding clinicians about the epidemiologic patterns of FUO in their regions

Update in hypertension: the seventh joint national committee report and beyond

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation on and Treatment of High Blood Pressure [JNCVII] had new key messages that need to be highlighted for practicing physicians. More than two years has elapsed since its publication and several important trials and meta-analyses were published during this period. Most of these publications supported and reinforced the JNC-VII recommendations, but others did not fully agree. Thus, some questions have arisen that need to be addressed in future research. This review will discuss what is new in JNC-VII and post-JNC-VII evidence that supports or disputes the recommendations. In addition, the results of other significant trials will be addressed. Finally, we outline the clinical "bottom line" and emphasize the practical application of this evidence