Painless Orbital Bone Infarction in a Child with Sickle Cell Anemia: A Case of Misdiagnosed Periorbital Cellulitis.

BACKGROUND Sickle cell orbitopathy is a rare complication of sickle cell disease that closely mimics other conditions, such as orbital cellulitis and osteomyelitis. We report a case of painless orbital bone infarction masquerading as periorbital cellulitis in a child with sickle cell anemia. CASE REPORT A 4-year-old Saudi girl with sickle cell disease presented to our hospital with vaso-occlusive crisis characterized by bilateral lower limb pain and painless left orbital swelling. On examination, she had swelling of the left upper eyelid with redness and mild ptosis (margin reflex distance 1 was 2 mm) without proptosis. Magnetic resonance imaging with contrast showed bilateral sub-periosteal heterogeneous collections (2×0.8×2.1 cm in the superolateral wall of the left orbit and 1×0.6 cm in the inferolateral wall of the right orbit), with intermediate-to-high T1 signal intensity and high T2 signal, causing a mass effect on the adjacent superior and lateral rectus muscles. The patient was treated with systemic antibiotics and supportive treatment for vaso-occlusive crisis under the care of the pediatric team and was discharged without complications. CONCLUSIONS The diagnosis of sickle cell orbitopathy can be challenging, and an accurate diagnosis is essential to ensure appropriate management. Thus, we report the case of a 4-year-old child with painless sickle cell orbitopathy masquerading as pre-septal cellulitis.

Examining the Association Between Parental Socioeconomic Status and Preterm Birth Using Multidomain Social Determinants Scale in a Tertiary Care Center in Saudi Arabia.

Objectives Socioeconomic status (SES) plays a conflicting role in preterm birth (PB). This study evaluated the association between SES and PB using, for the first time, a multidomain scale, validated for Saudi Arabia, with a scoring system and examined the effect of each SES domain on PB. The secondary outcome was to determine the effects of SES on birth weight (BW) and the subcategories of PB and BW. Methods This cross-sectional study was conducted between May 2017 and August 2017 at a National Guard tertiary center in Jeddah, Saudi Arabia. A total of 477 parents were interviewed using the Elzahrany R. SES scale. Results The rate of PB was 11.5%, with no significant differences among the high, middle, and low SES classes (13%, 11%, and 12.5%, respectively). There were no patients in the very low SES in this specific population. None of the maternal or neonatal characteristics were significantly different among SES classes except maternal age (p value = 0.03), and antenatal care recorded visits "booking" status (p value = 0.012). Stratified analysis for PB subcategories showed the lower SES classes had higher moderate (3.8%) and extreme (1.6%) PB. For BW subcategories, large for gestational age (LGA) infants were higher in the high SES class (13%). However, the lower SES classes had higher rates of lower BW. The association between SES and PB remained not significant after adjusting for the maternal age and antenatal booking status. Conclusion There was no association between SES and PB at a tertiary center providing universal care to the National Guard using multidomain socioeconomic determinants with a scoring system. However, lower SES was associated with lower BW. The use of the "polysocial risk score" based on locally validated surveys should be considered in any health research that examines the effects of socioeconomic determinants.