Non-traumatic bilateral epidural hematoma in a child with sickle cell anemia: A case report and a review of the literature.

OBJECTIVE: To report a rare case of spontaneous bilateral epidural hematoma (EDH) in a 10-year-old Nigerian child with sickle cell disease (SCD) and review the literature regarding this unusual complication. METHODS: We present a case of a pediatric patient with SCD who developed a spontaneous bilateral EDH and discuss the potential underlying mechanisms, management approaches, and outcomes. We also conducted a literature review of existing cases of spontaneous EDH in patients with SCD. RESULTS: Our patient initially presented with a subgaleal hematoma and underlying bilateral EDH, but she was sent home without any neurosurgical consultation. Two years later, she returned with altered consciousness and left-sided weakness, revealing an increased size of the EDH with a noticeable mass effect. She underwent a successful emergency bilateral craniotomy, with noticeable improvement in her level of consciousness and left-sided weakness post-operatively. In our literature review, we found 40 reported cases of spontaneous EDH in SCD patients, with a male predominance (82.5%). The average age of patients was 15.282 years. The most common hematoma location was bifrontal (20%) and the most reported symptom was headache (47.5%). Most patients (97.5%) were already known cases of SCD. Among those treated, 77.5% survived. CONCLUSION: Spontaneous bilateral EDH in SCD patients is an uncommon complication, with a variety of proposed pathophysiological mechanisms. Prompt recognition and appropriate management, either conservative or surgical, are crucial to improve outcomes. Our case and literature review underscore the importance of considering spontaneous EDH in SCD patients presenting with neurological symptoms, even in the absence of trauma. Further research is needed to elucidate the precise etiology, identify risk factors, and optimize management approaches for this rare complication in SCD patients.

The changeable dynamics between glycaemic control and neuropathy risk across the lifespan of Saudi diabetic patients; A survey in diabetes healthcare facility.

Background and Aims: Peripheral neuropathy is a common diabetic complication. It is linked to poor glycaemic control and longer duration of diabetes. We explored the association between HbA1c and neuropathy risk considering the duration of diabetes in a sample of Saudi diabetic patients. Method: We conducted a monofilament test on 343 diabetic patients referred to our specialist diabetology centre in Saudi Arabia. We utilized a multiple generalized logistic regression model with a binary outcome related to neuropathy complications. Results: We found that over four out of every five patients have peripheral neuropathy. The interaction between HbA1c and duration was significant (estimate = -0.02802, P = 0.00534), a positive association between neuropathy and both HbA1c (increased risk by 46.2%, P = 0.03222) and DM duration (increased risk by 19.6%, P = 0.04497). Conclusions: The shorter the duration of diabetes, the more positive the relationship between HbA1c and peripheral neuropathy. In patients living for over 40 years with diabetes, HbA1c was higher among those who did not have peripheral neuropathy. It could be argued that this is an artefact of survival as poorer glycaemic control will likely result in higher mortality in earlier years of the diabetes career.

Depression Among Patients With Type 2 Diabetes Mellitus at King Abdulaziz University Hospital (KAUH): A Cross-Sectional Study.

BACKGROUND:  Depression can increase the risk of diabetes-related complications, healthcare expenditures, and morbidity in patients with type 2 diabetes mellitus (T2DM). There have been increasing cases of diabetes in Saudi Arabia; however, research correlating depression with diabetes is lacking. The aim of this study was to find out how common depression is among T2DM patients at King Abdulaziz University Hospital (KAUH), Jeddah, and assess any additional risk factors for depression in these patients. METHODOLOGY:  A cross-sectional study using computer-assisted telephone interviews was conducted among patients with T2DM from June to August 2021. A total of 215 participants completed the survey. Symptoms and signs of depression were assessed using the Patient Health Questionnaire (PHQ-9). Univariate, bivariate, and multivariate statistical analyses were used to determine the prevalence and risk factors associated with depression. RESULTS: Depression was shown to be prevalent in 54% of type 2 diabetes patients, with the most common associated risk factors being not exercising (p=0.00) and having at least one diabetes-related complication (p=0.001). There was no evidence of a significant relationship between depression and gender or age, although females were, in general, more depressed than males. CONCLUSION: Diabetic patients have a significantly high prevalence of depression; therefore, it is vital to conduct regular screening for depression in patients diagnosed with T2DM.