Emergency management of subdural hematoma

Background: Subdural hematoma is extra-cerebral accumulation of blood between the dura matter and the subarachnoid layer. It is almost always caused by trauma or due to blood thinning therapies, and occurs due to rupture of bridging veins. Acute subdural hematoma is an emergency situation and requires prompt diagnosis using CT most of the time, and management requires surgery as well as reversal of anticoagulants

Materials and methods: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1985, through February 2017. The following search terms were used: subdural hematoma, emergency management of subdural hematoma, CT vs. MRI in diagnosis of subdural hematoma, treatment of subdural hematoma

Aim: In this review, we aim to study the etiology of subdural hematoma, explore how to diagnose and manage it in the emergency department

Conclusion: Subdural hematoma is an important clinical presentation that needs proper and prompt surgical management and treatment. Treatment should be as less invasive as possible, with higher efficacy and lower recurrence rates. Non-surgical approaches are still being studied with no proven efficacy for them until now

Prevalence of depression among diabetic patients in Makkah

Background: Diabetes mellitus [DM] is a major health problem that is associated with psychological, as well as physical, complications particularly depression. Depression is well-known to be prevalent among diabetic patients and to be associated with poor glycemic control, poor adherence to medication, increased diabetic complication and higher risk of mortality

Objectives: The purpose of the study is to determine the prevalence rate of depression among diabetic patients in primary health care units and diabetic centers at Makkah city - Saudi Arabia, and to explore the associated factors that co-exist with depression among diabetic patients

Methods: This was a descriptive cross-sectional study conducted on 382 diabetic patients [both type I and II] recruited from diabetic centers at Al-Noor hospital, Hera'a hospital, and East of Al-aziziah hospital in Makkah, KSA. Data were collected via a self-administered questionnaire including demographic variables and the Arabic translation of Patient health questionnaire the Tunisian version [PHQ-9]. The data collected were analyzed using SAS 9.4

Results: After data analysis of the 382 participants 43.19% were males and 56.81% were females, with a mean age of 50.28+/-11.43 years. The prevalence of depression was 20.68%, with 12.83%, 7.07%, and 0.79% having moderate, moderately severe, and severe depression, respectively. Hypertension, duration of hypertension, number of co-morbidities, and high education level were significantly associated with depression [p=0.0111, 0.0029, 0.0491, and 0.0158, respectively]. The odd's ratio of number of co-morbidities was 1.565 [p=0.0039]

Conclusions: Depression and suicidality are prevalent among diabetic patients in Makkah. When diabetes co-exists with hypertension and/or other comorbid illnesses the prevalent doubles. Hypertension, increased number of associated co-morbidities, and high educational level are significantly associated with depression in diabetic patients

Acute and chronic sinusitis causes and management

Sinusitis is categorized by inflammation of the lining of the paranasal sinuses. As the nasal mucosa is instantaneously involved and as sinusitis infrequently occurs without concurrent rhinitis, rhinosinusitis is currently the preferred term for this condition. Acute sinusitis is a clinical diagnosis; thus, an understanding of its presentation is of paramount importance in differentiating this entity from allergic or vasomotor rhinitis and common upper respiratory infections. No precise clinical sign or symptom is sensitive or specific for acute sinusitis, so the overall clinical impression should be used to guide management. Chronic sinusitis is an inflammatory procedure that includes the paranasal sinuses and persists for 12 weeks or longer. The literature has reinforced that chronic sinusitis is nearly always accompanied by concurrent nasal airway inflammation and is frequently preceded by rhinitis symptoms; hence, the term chronic rhinosinusitis [CRS] has evolved to more accurately define this condition. Treatment of sinusitis, whether medical or surgical, is intended at decreasing inflammation and obstruction in the sinonasal passages. Antibiotics, even though frequently used in sinusitis, ought to not be managed unless there is suspicion of an acute bacterial infection