Adnexal torsion is a cause of severe pelvic pain in reproductive aged women and during pregnancy. Adnexal torsion occurs when there is a complete turn of the ovary, tube, or both resulting in impaired blood flow to the ovary. The diagnosis of adnexal torsion is sometimes challenging due to the enlarged effect of the uterus, the displacement of abdominal and pelvic structures and the nonspecific symptoms in pregnancy. Therefore, prompt diagnosis is essential for better maternal and neonatal outcomes. The gold standard for confirmation and treatment of ovarian torsion is surgery. Laparoscopy and Laparotomy are surgical options with defined risks and benefits. Therefore, choosing the best surgical technique and surgical procedure are of utmost importance to decrease the chances of adverse events intra and postoperatively. Little literature exists regarding the laparoscopic approach of an ovarian torsion during the second trimester. Our case is a 20-week pregnant patient who had a 1080 degree rotation of the left adnexa. She required laparoscopy for adnexal detorsion and had good intraoperative, postoperative, maternal, and neonatal outcomes following management.
Aortic dissection is an uncommon yet frequently fatal illness. Patients generally present with tearing chest pain with possible acute hemodynamic instability. Hence, early diagnosis and intervention is critical for survival. This is a case of a 62-year-old male who was transferred to our emergency department for severe chest pain, left side hemiplegia, left hemianopsia, left facial weakness, suggesting a right-sided stroke. A chest computed tomography angiogram showed an extensive circumferential aortic dissection of the intimal layer involving the great vessels. Antiplatelet medications were withheld, nicardipine was started, and the cardiothoracic surgeon was consulted. There was no indication for surgery, and patient was admitted to the intensive care unit. We highlight here the importance of considering an aortic dissection in patients who present with neurological symptoms and an acute history of tearing chest pain.
Introduction: Basic Life Support (BLS) is the rapid detection of cardiac arrest and the initial adequate response to maintain adequate ventilation and circulation. Multiple studies around the world have shown that when used infrequently, BLS skills will deteriorate within 3 to 6 months after training, even though the theoretical knowledge was retained longer. We aim to identify differences in training and knowledge among different physician populations according to their age, specialty, and area of practice and provide areas of improvements. Methods: A multi-center prospective cross-sectional study was conducted in 14 institutions around all areas of Lebanon from January 2017 to December 2019. A structured questionnaire adapted from pretest questionnaire that has been previously used in similar studies was implemented. Data Analysis was performed using the R software version 3.5.1. We used graphical boxplot representation of the data to demonstrate the distribution of our results. Results: 201 responses from randomly chosen physicians were collected. Out of these 201 physicians, ten physicians answered all questions correctly and twelve others only answered two questions correctly. Only 39.80% (80) of physicians achieved “sufficient knowledge” level. Conclusion: This present study highlights the need for BLS course to be implemented and given to all physicians and the importance of a refreshment course to all physicians.
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