Ovarian torsion: A retrospective case series at a tertiary care center emergency department.

Ovarian torsion (OT) is a gynecological emergency that can have diverse clinical presentations makings its diagnosis especially challenging. Few studies exist in the literature describing the clinical presentation as well as the management of OT in the emergency department (ED). This study aims to describe the clinical presentation, physical examination, emergency management, radiographic and intraoperative findings, histopathology reports and the time-to-intervention metrics of OT cases presenting to the emergency room of our tertiary care center. Data was collected by a retrospective chart review of all OT cases that presented to our ED over a period of 1 year. A total of 20 cases were included in the final analysis. The incidence of OT in the ED was 157.4 per 100 000 visits of women in the reproductive age group. All patients were women of reproductive age, with a mean age of 27.3 years. A total of 15 patients (78.9%) presented within 24 hours of symptom onset. The most common presenting symptom was abdominal pain (95%, 19/20) with most localizing to the right lower quadrant (60%, 12/20), followed by nausea and vomiting (90%, 18/20). Almost all patients (95%, 19/20) required opioids for pain management. The majority (80%, 16/20) were diagnosed by ultrasound prior to surgery, whereas (20%, 4/20) went straight to surgery based on a high index of clinical suspicion. Among those who underwent ultrasound, ovarian cyst was present in (75%, 12/16) while (68.9%, 11/16) showed ovarian enlargement and (50%, 8/16) showed abnormal ovarian blood flow. All patients except one patient underwent operative management. Out of the 19 patients who underwent surgery, the majority of patients (94.7%, 18/19) had viable ovaries with the exception of 1 patient (5.3%) who required a salpingo-oophorectomy post ovarian detorsion. A total of 13 cases included histopathologic review of specimens out of which 6 (46.2%) had a mature cystic teratoma. The mean time from door to ultrasonography was 1.4 hours and from door to surgery was 11.4 hours. Our study provides valuable insights into the incidence, clinical presentation, physical examination, emergency management, ultrasonographic and intraoperative findings, histopathology reports as well as the time-to-intervention metrics of OT patients presenting to the ED.

A Case Report of a Lebanon Viper (Montivipera bornmuelleri) Envenomation in a Child.

INTRODUCTION: Snake envenomation is a serious public health concern. In the Middle East little is known about snakebite envenomation, which raises several challenges for emergency physicians caring for these patients. CASE REPORT: We report the case of a five-year-old boy bitten by a rare snake, Montivipera bornmuelleri, who presented to an emergency department in Lebanon. We also discuss the proper management of snake envenomation. CONCLUSION: This case is unique as snakebites in Lebanon are poorly studied, and little is known about the epidemiology and clinical manifestations of local snakebites.

Structure and evaluation of a residency research program in a university hospital.

BACKGROUND: Most academic medical institutions lack a structured program that provides residents with an in-depth research training. The objectives of this paper are to describe a comprehensive residency research program at a university hospital, and to assess the pre- post-self-assessment of research capabilities of resident for the evaluation of the program. METHODS: The residency research program (RRP) was implemented in 2011 as an essential component of the residency program at the American University of Beirut Medical Center. Categorical residents are required to carry out a research project and go through all the steps of the research process from identifying a topic to writing a manuscript. As for evaluating the program, data were collected from residents who graduated between 2014 and 2016 using a questionnaire, which included the overall evaluation of the program, self-assessment on research-related tasks pre- and post- joining the program, as well as general recommendations. The mean scores on the five-point Likert scale were transformed into percentages (0-100%). The average was calculated and the difference in the means was reported. RESULTS: Overall, 103 residents from the different clinical departments were included in this study. Residents' self-assessment showed a 19.3% improvement in research-related tasks before and after completion of the RRP (P < 0.0001). Most of the residents have either published or are in the process of publishing their projects (34 and 55.3%, respectively). Time management was the most reported challenge. Generally, the program was evaluated positively. CONCLUSION: The RRP is a unique, well-structured program, encompassing residents from various clinical departments, which enhances residents' research capabilities.

Managing Lafora body disease with vagal nerve stimulation.

A 17-year-old female, of consanguineous parents, presented with a history of seizures and cognitive decline since the age of 12 years. She had absence, focal dyscognitive, generalized myoclonic, and generalized tonic-clonic seizures, all of which were drug resistant. The diagnosis of Lafora body disease was made based on a compatible clinical, EEG, seizure semiology picture and a disease-causing homozygous mutation in the EPM2A gene. A vagus nerve stimulator (VNS) was inserted and well tolerated with a steady decrease and then stabilization in seizure frequency during the six months following insertion (months 1-6). At follow-up, at 12 months after VNS insertion, there was a persistent improvement. Seizure frequency during months 7-12, compared to pre-VNS, was documented as follows: the absence seizures observed by the family had decreased from four episodes per month to 0 per month, the focal dyscognitive seizures from 300 episodes per month to 90 per month, the generalized myoclonic seizures from 90 clusters per month to eight per month, and the generalized tonic-clonic seizures from 30 episodes per month to 1.5 per month on average. To our knowledge, this is the second case reported in the literature showing efficacy of VNS in the management of seizures in Lafora body disease.