Characteristics of dengue fever in a large public hospital, Jeddah, Saudi Arabia

This study aims to determine demographic, clinical and laboratory profile along with disease outcome of all confirmed cases of dengue fever [DF] and dengue hemorrhagic fever [DHF] admitted in King Abdulaziz Hospital and Oncology Center, Jeddah, Saudi Arabia. We also want to highlight the significance of implementing a well targeted community based disease prevention program. All patients admitted from May 2004 till April 2005 with a suspected diagnosis of DF and DHF were followed. All cases confirmed by a positive serology [IgM alone or IgM and IgG] to dengue fever were studied in detail to determine age, gender, ethnicity, monthly distribution, clinical and laboratory profile. A total of 80 patients were admitted with a suspected diagnosis of DF. Among these, 39 [48.75%] patients were confirmed by positive serology to have the disease. Male to female ratio was 3.3:1. Their ages ranged from 2 to 60 years with a mean of 27.6 + 11.2. Twelve patients were Saudis, while the rest were non-Saudis coming from different countries in Asia, Africa and Middle East. Maximum number of patients [48.72%] was seen in the summer months of June, July and August. Commonest presentation was fever [100%], headache [48.72%], myalgias [66.7%] and vomiting [25.64%]. Rash, hemorrhagic manifestations and positive tourniquet test were relatively uncommon. Only two patients fulfilled WHO criteria of DHF. Main hematological abnormalities were thrombocytopenia [79.49%] and leucopenia [48.72%]. Significant elevation of PTT was observed in 25.64% of patients. Abnormal liver function tests with high transaminases were seen in about 66.7% of patients, whereas 33.33% of patients had significantly elevated creatine kinase. All patients improved clinically with improvement of chemical and hematological parameters. None of the patients died in this series. DF continues to be a significant health problem in Western region of Saudi Arabia. Large number of pilgrims coming from disease endemic areas all over the world facilitates the continued introduction of dengue virus with different strains. Fortunately there has been no serious outbreak of dengue fever in recent years. A sharp vigilance is required by concerned authorities to prevent and minimize any future outbreak. It is extremely important to implement and maintain an effective, sustainable and community based disease prevention program

Abdominal tuberculosis: review of 78 cases

Seventy-eight patients with abdominal tuberculosis [TB] were admitted to the medical and surgical departments at two major teaching hospitals in Jeddah during the period from January 1991 to August 2001. They were young patients with average age of 31 years. They all belonged to low socio-economic class. The majority of patients presented with non-specific symptoms which included fever, weight loss, abdominal pain, vomiting and change of bowel habit. There was a predilection for a single organ involvement. The peritoneum being the commonest site [61.50%] followed by the liver [16. 60%], mesenteric lymph nodes [10.20%], small bowel [3.80%] and colon [2.60%]. The spleen, appendix, pancreas and perineum were involved a 1.3% [one case each]. Abnormal chest x-ray suggestive of active or old tuberculosis and positive Mantaux test were present in 41% and 14.60% of patients respectively. Laparoscopy was helpful in establishing the diagnosis of peritoneal tuberculosis in 43 patients. Seven patients [8.90%] required various surgical procedures. The outcome of treatment with anti-TB chemotherapy for 6 months was successful. One patient developed post-operative abdominal fistula and two patients died. The morbidity was 1.3% and the mortality was 2.56%

Diffuse alveolar hemorrhages and hemorrhagic pleural effusion after thrombolytic therapy with streptokinase for acute mycardial infarction

Thrombolytic therapy with streptokinase is commonly used in acute myocardial infarction and has markedly reduced morbidity and mortality from this condition. However, it can cause various hemorrhagic and immunological complications.We report a patient who developed diffuse pulmonary hemorrhages and bilateral hemorrhagic pleural effusion after thrombolytic therapy with streptokinase for acute myocardial infarction. This was recognized by a drop of hematocrit, pulmonary infiltrates, hemorrhagic pleural effusion and hypoxemia. The diagnosis was confirmed by demonstration of iron-laden macrophages [siderophages] in bronchoalveolar lavage. The patient required mechanical ventilation and recovered successfully. This combination of pulmonary hemorrhages and hemorrhagic pleural effusion following streptokinase therapy is extremely unusual and has not been reported previously