Rawan Abdulrahman

Sheehan syndrome is an uncommon cause of hypopituitarism resulting from ischemic pituitary necrosis following severe postpartum hemorrhage (PPH) and hypotension. Its presentation can be delayed and non-specific, and it is rarely reported in the context of mild PPH with severe hemolysis. Here, we describe a 31-year-old woman with underlying sickle cell disease (SCD) who developed panhypopituitarism and reversible cardiac dysfunction after an 11-week period of progressive symptoms following spontaneous vaginal delivery complicated by an estimated blood loss of 700 mL and severe hemolysis. Pituitary hormonal replacement therapy, together with heart failure treatment, resulted in marked clinical and biochemical improvement, with normalization of metabolic abnormalities and recovery of cardiac function. This case suggests a possible association between Sheehan syndrome and postpartum blood loss of 700 mL accompanied by severe hemolysis, though this remains hypothetical based on a single case.

Objective. Date fruit has been reported to have benefits in type 2 diabetes (T2D), though there is a concern, given the high sugar content, about its effects on glycemic control. Design and Setting. Prospective, interventional, randomized, parallel study. Participants. In total, 79 patients with T2D (39 male and 40 female). Intervention. Participants were randomly allocated to either 60 g date fruit or 60 g raisins daily of the equivalent glycemic index (amount split, given as midmorning and midafternoon snack) for 12 weeks. Main Outcome Measures. The primary outcome was to investigate the effect of date fruit on HbA1c and fasting blood glucose, and their variability, in patients with T2D in comparison to the same glycemic load of raisins. The secondary outcomes were to determine whether date fruit affected cardiovascular risk by measuring fasting lipids, C-reactive protein (CRP), blood pressure, and insulin resistance (IR) as measured by Homeostatic Model Assessment (HOMA-IR). Results. In total, 61 (27 female and 34 male) of 79 patients completed the study. There was no difference between or within groups for HbA1c or HbA1c variability, fasting glucose or glucose variability, insulin resistance (HOMA-IR), insulin sensitivity (HOMA-S), beta cell function (HOMA-B), the disposition index, lipids, systolic (SBP) or diastolic blood pressure (DBP), or C-reactive protein (CRP) (p > 0.05). Conclusion. No improvement in glycemic indices was seen following supplementation of 60 g daily date fruit or raisins, though neither had a deleterious effect on glycemic control over a 12-week period, indicating their safety when consumed in T2D. Additionally, no beneficial therapeutic effects of date fruit on other cardiovascular indices in T2D were seen.