1
|
Mohamad H, Yared G, Al Hassan J, Nakib H, El Hajjar C, Ghazal K. Vasa previa Type 3: Advocating for universal screening and investigation of risk factors: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241253747. [PMID: 38764916 PMCID: PMC11102669 DOI: 10.1177/2050313x241253747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/23/2024] [Indexed: 05/21/2024] Open
Abstract
Vasa previa is a critical obstetric condition marked by unprotected fetal vessels near the cervical os, traditionally divided into Types 1 and 2, based on its association with velamentous cord insertion and accessory placental lobes, respectively. The recent introduction of Type 3 vasa previa addresses atypical cases. We report a unique intrapartum diagnosis of Type 3 vasa previa in a 39-year-old at 38 weeks of gestation, identified during labor induction without prior risk indicators. Despite lacking traditional risk factors, advanced imaging and clinical vigilance led to a primary cesarean delivery, confirming the diagnosis through intraoperative findings of three aberrant vessels with marginal cord insertion. This case emphasizes the critical importance of considering vasa previa in prenatal and intrapartum care to prevent adverse outcomes, advocating for universal screening practices to identify this rare but significant condition.
Collapse
Affiliation(s)
- Hawraa Mohamad
- Obstetrics and Gynecology Resident at Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| | - Georges Yared
- Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
| | - Jihad Al Hassan
- Department of Obstetrics and Gynecology, Al Zahraa Hospital University Medical Centre, Beirut, Lebanon
| | - Hamza Nakib
- The Lebanese American University, Beirut, Lebanon
| | - Charlotte El Hajjar
- Department of Obstetrics and Gynecology at Rafik Hariri University Hospital, Beirut, Lebanon
| | - Kariman Ghazal
- Department of Obstetrics and Gynecology at Rafik Hariri University Hospital, Beirut, Lebanon
- Department of Obstetrics and Gynecology at Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| |
Collapse
|
2
|
Yared G, al Hassan J, Tachdjian A, El Hajjar C, Ghazal K. Unexpected discovery of fetal bones instead of an intrauterine device: A unique gynecological case report. SAGE Open Med Case Rep 2024; 12:2050313X241249628. [PMID: 38756329 PMCID: PMC11097719 DOI: 10.1177/2050313x241249628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 04/06/2024] [Indexed: 05/18/2024] Open
Abstract
This case report details an unusual and unexpected finding in a 37-year-old woman with a history of two cesarean sections, who had an intrauterine device implanted. The patient presented with symptoms of abnormal uterine bleeding and dysmenorrhea. An initial ultrasound confirmed the presence of the intrauterine device. However, a startling discovery was made during the intrauterine device removal procedure: fetal bones were found within the patient. This case underscores the importance of thorough diagnostic evaluations in gynecological practice, particularly when dealing with patients who have complex gynecological histories. Significantly, it brings to light the necessity of employing hysteroscopy for comprehensive diagnostic assessment in cases of abnormal uterine bleeding post-abortion. This approach could aid in identifying rare and unexpected findings, such as retained fetal bones, which might be missed by conventional ultrasound. The report emphasizes the need for vigilance and thoroughness in gynecological examinations and contributes to the understanding of potential complications and anomalies associated with intrauterine device usage and post-abortion care.
Collapse
Affiliation(s)
- Georges Yared
- Assistant Professor Obstetrics and Gynecology Department, Lebanese American University, Beirut, Lebanon
| | - Jihad al Hassan
- Obstetrics and Gynecology Department, Rafik Hariri Hospital University Medical Center, Beirut, Lebanon
- Associate Professor Obstetrics and Gynecology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Obstetrics and Gynecology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Head of Obstetrics and Gynecology Department, Al Zahraa Hospital University Medical Centre, Beirut, Lebanon
| | - Annie Tachdjian
- Obstetrics and Gynecology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Charlotte El Hajjar
- Head of Obstetrics and Gynecology Department, Rafik Hariri Hospital University Medical Center, Beirut, Lebanon
| | - Kariman Ghazal
- Obstetrics and Gynecology Department, Rafik Hariri Hospital University Medical Center, Beirut, Lebanon
- Associate Professor Obstetrics and Gynecology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| |
Collapse
|
3
|
Moussa M, Issa H, Al Hassan J, Ghazal K. Diagnostic and treatment patterns in urinary and genital tract infections: insights from a referral clinic in Beirut, Lebanon. World J Urol 2024; 42:68. [PMID: 38308683 DOI: 10.1007/s00345-024-04770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/15/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Urinary Tract Infections (UTIs) and Genital Tract Infections (GTIs) are common yet serious health concerns. Precise diagnosis is crucial due to the potential severe consequences of misdiagnosis. This study aims to distinguish between UTIs and GTIs, highlighting the importance of accurate differentiation. MATERIALS AND METHODS The study encompassed 294 patients, categorized into 4 groups: Group GNI (no infection, N = 57), Group GUI (urinary infection, N = 52), Group GGI (genital infection, N = 139), and Group GGUI (both infections, N = 46). Methods included patient interviews, clinical examinations, and laboratory tests such as urine and vaginal swab cultures. RESULTS The investigation revealed no significant differences in age, BMI, residency, or nationality across groups. However, socioeconomic status varied, with Group GNI having the lowest proportion of low socioeconomic status. In obstetrical characteristics, non-pregnancy rates were higher in Groups GUI and GGUI, with GGUI showing a notably higher abortion rate. Symptom analysis indicated lower symptom prevalence in Group GNI, with pain, itching, pruritus, and vaginal discharge being less frequent, suggesting a link between infection presence and symptom severity. Treatment patterns showed higher usage of ciprofloxacin, antifungals, and vaginal tablets in Groups GUI and GGUI. Laboratory findings highlighted significant Leucocyte Esterase presence and variations in WBC and RBC counts, particularly in Group GGUI. CONCLUSION The study emphasizes the need for advanced diagnostic techniques, especially those focusing on individual microbial patterns, to enhance UGTI diagnosis. Variations in symptom presentation and treatment across groups underline the necessity for personalized diagnostic and treatment strategies.
Collapse
Affiliation(s)
- Mohamad Moussa
- Urology Department, Faculty of Medicine, Lebanese University, Al Zahraa Hospital, Beirut, Lebanon
| | - Hussein Issa
- Urology Department, Lebanese University, Beirut, Lebanon
| | - Jihad Al Hassan
- Obstetrics and Gynecology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Kariman Ghazal
- Obstetrics and Gynaecology Department, Lebanese University, Beirut, Lebanon.
- Obstetrics and Gynaecology Department, Al Zahraa Hospital University Medical Centre, Beirut, Lebanon.
- Obstetrics and Gynecology Department, Rafik Hariri Hospital University Medical Center, Beirut, Lebanon.
| |
Collapse
|
4
|
Yared G, Tachdjian A, El Kazwini MEJ, Azzi J, El Hajjar C, Ghazal K. A case study on using an intrauterine foley catheter to reduce postpartum bleeding in a patient with hemophilia. Int J Gynaecol Obstet 2024; 164:347-348. [PMID: 37753875 DOI: 10.1002/ijgo.15123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/17/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023]
Abstract
SynopsisCase of a pregnant patient suffering from severe hemophilia A who had effective uterine foley tamponade to treat postpartum hemorrhage.
Collapse
Affiliation(s)
| | - Annie Tachdjian
- Obstetrics and Gynecology Department, Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | | | - Joelle Azzi
- Pharmacist Department, Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Charlotte El Hajjar
- Obstetrics and Gynecology Department, Rafik Hariri Hospital University Medical Center, Beirut, Lebanon
- Obstetrics and Gynecology Department, Al Zahraa Hospital University Medical Centre, Beirut, Lebanon
| | - Kariman Ghazal
- Obstetrics and Gynecology Department, Al Zahraa Hospital University Medical Centre, Beirut, Lebanon
- Obstetrics and Gynecology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| |
Collapse
|
5
|
Ghazal K, Morales O, Barjon C, Dahlqvist G, Aoudjehane L, Ouaguia L, Delhem N, Conti F. Early high levels of regulatory T cells and T helper 1 may predict the progression of recurrent hepatitis C after liver transplantation. Clin Res Hepatol Gastroenterol 2019; 43:273-281. [PMID: 30713032 DOI: 10.1016/j.clinre.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Immune response failure against hepatitis C virus (HCV) has been associated with an increased regulatory T cell (Treg) activity. After liver transplantation (LT), 80% of patients experience an accelerated progression of hepatitis C recurrence. The aim of this work was to assess the involvement of Tregs, T helper (Th) 1, 2 and 17 cells in recurrent hepatitis C. METHODS Peripheral blood cells obtained before and one month after LT from 22 recipients were analysed. Forty-four key molecules related to Treg, Th1, 2 and 17 responses, were evaluated using qRT-PCR. Liver recipients were classified in two groups according to graft fibrosis evaluated by the METAVIR score on the biopsy performed one year after LT (mild: F ≤ 1, n = 13; severe: F > 1, n = 9). Patients developing a severe recurrence were compared with patients with a mild recurrence. RESULTS mRNA levels of Treg markers obtained one month after LT were significantly increased in patients with a severe disease course when compared to patients with a mild recurrence. Markers of the Th1 response were elevated in the same group. No differences in the markers determined before LT were observed. CONCLUSION These findings suggest that Treg, induced by a multifactorial process, which could include a strong Th1 response itself, may play a role in suppressing the early antiviral response, leading to a severe recurrence of hepatitis C.
Collapse
Affiliation(s)
- K Ghazal
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMR_S 938, Saint-Antoine Research Center, 75012 Paris, France; AP-HP, Bicêtre Hospital, Biochemistry Laboratory, 94275 Le Kremlin-Bicêtre cedex, France.
| | - O Morales
- CNRS, UMR8161, Institut de Biologie de Lille, Université de Lille, Institut Pasteur de Lille, IFR 142, 59021 Lille cedex, France
| | - C Barjon
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMR_S 938, Saint-Antoine Research Center, 75012 Paris, France; De Duve Institute, Université catholique de Louvain, 1200 Brussels, Belgium
| | - G Dahlqvist
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMR_S 938, Saint-Antoine Research Center, 75012 Paris, France; Cliniques Universitaires Saint-Luc, 1200 Woluwe-Saint-Lambert, Belgium
| | - L Aoudjehane
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMR_S 938, Saint-Antoine Research Center, 75012 Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), 75013 Paris, France
| | - L Ouaguia
- CNRS, UMR8161, Institut de Biologie de Lille, Université de Lille, Institut Pasteur de Lille, IFR 142, 59021 Lille cedex, France
| | - N Delhem
- CNRS, UMR8161, Institut de Biologie de Lille, Université de Lille, Institut Pasteur de Lille, IFR 142, 59021 Lille cedex, France
| | - F Conti
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMR_S 938, Saint-Antoine Research Center, 75012 Paris, France; AP-HP, Pitié-Salpêtrière hospital, Unité Médicale de Transplantation Hépatique, 75013 Paris, France
| |
Collapse
|
6
|
Abstract
OBJECTIVE To study the clinical risk factors for preterm premature rupture of membranes (PROM). METHOD We conducted a case-control study of 138 patients with PROM between 24 and 35 weeks' gestation and 267 control subjects. RESULTS In stepwise multiple logistic regression models, the population of cases was more likely to be of low social class. Other risk factors for PROM were smoking in pregnancy, 1st or 2nd-3rd trimester hemorrhages, cervical incompetence and a documented cervico-vaginal infection during index pregnancy. First trimester hemorrhage and a documented cervico-vaginal infection during index pregnancy were associated with preterm PROM both in nulliparous and in multiparous women. CONCLUSION Few potentially remediable risk factors are associated with the occurrence of preterm PROM.
Collapse
Affiliation(s)
- A Spinillo
- Department of Obstetrics and Gynecology, IRCCS Policlinico S. Matteo, University of Pavia, Italy
| | | | | | | | | | | |
Collapse
|