Evaluation of the benefit of indocyanine green as an educational and practical tool for ureteral identification in laparoscopic pelvic surgery: a cross-sectional study.

BACKGROUND: Indocyanine green (ICG) is a visible near-infrared fluorescent dye. Several studies have reported its benefit in identifying important anatomical structures, tissue vascularization, and sentinel lymph nodes in the case of tumors. Studies have shown that ICG is critical and safe in gynecologic surgeries. However, research on how ICG dye can help surgeons in laparoscopic surgeries correctly identify the course of the ureter has yet to be further investigated. METHOD: This cross-sectional study enrolled 62 gynecology attending and resident surgeons who were asked to identify the course of the ureter on images of laparoscopic surgeries. The results were then compared with images in which ICG dye highlighted the course of the ureter. The purpose of this study was to detect the ability of surgical assistants and residents to adequately identify the course of the ureter in laparoscopic pelvic surgeries. RESULTS: No statistically significant differences were found in terms of year of residency, years of experience, number of laparoscopic procedures attended, and correct identification of ureter course. ICG proved useful in identifying the correct ureteral trajectory. CONCLUSIONS: ICG can be a valuable tool to improve the correct identification of ureters and improve surgical outcomes.

Post-partum hemorrhage: a multidisciplinary approach to 'the golden hour' quantum leadership and communication.

Background: Quantum leadership in postpartum hemorrhage (PPH) simulation training remains underexplored. Quantum leaders excel in PPH's chaotic settings, differing from traditional leaders. Aiming: To assess the impact of simulation training on quantum leadership skills in maternity teams. Research design: A quasi-experimental approach. Sample: 60 maternity professionals from Rafik Hariri University Hospital, Lebanon. Tools: Structured interviews, observational checklists and a leadership skills scale. Results: Most participants had limited PPH simulation experience and showed an initial low proficiency. Significant improvements were evident, post training. Conclusion: Simulation training enhances quantum leadership in PPH management among maternity professionals.

We looked at how a new style of leadership, called 'quantum leadership', can help medical teams better manage a serious childbirth complication called postpartum hemorrhage (PPH). This leadership style is especially good in unexpected and chaotic situations like PPH. Our study took place in a special training lab at Rafik Hariri university hospital in Lebanon, involving 60 medical professionals. We found that many had not been trained this way before and had less than 10 years of experience. Their starting skills and confidence were low. However, they showed significant improvement after our training. This shows the importance of this kind of training for childbirth care professionals.

Vasa previa Type 3: Advocating for universal screening and investigation of risk factors: A case report.

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.

Unexpected discovery of fetal bones instead of an intrauterine device: A unique gynecological case report.

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.

Twin pregnancy: Live fetus with complete hydatidiform molar-A case report.

Gestational trophoblastic disease encompasses a range of lesions, each culminating in varied clinical manifestations. Among these, the simultaneous occurrence of molar changes within the placenta and a viable fetus remains a particularly elusive and challenging presentation, posing intricate dilemmas for obstetricians. In this article, we delineate a distinct case involving a 21-year-old woman with a history of consanguineous marriage. She was referred from Médecins Sans Frontières to the Rafic Hariri University Hospital during her 19th week of gestation. With an unremarkable medical history and uncomplicated previous pregnancies, her presentation to the Rafic Hariri University Hospital was punctuated by symptoms of premature labor. Clinical evaluations revealed ruptured membranes, a fetus-positioned breech, and discernible complications tied to the placental morphology. Given these clinical findings, a decision was made in favor of a Cesarean delivery. Prior to this, the patient had been administered corticosteroids and tocolytics. Subsequent delivery produced a live male infant at 34 + 5 gestational days, and further assessment unveiled a complete molar pregnancy. The coexistence of a viable fetus alongside a complete molar pregnancy is an infrequently documented phenomenon, underlining the clinical significance of this case. A comprehensive literature survey reinforced the exceptional nature of our findings. Postpartum, both the mother and neonate were monitored for a month, ensuring their well-being. This case accentuates the paramountcy of prompt and precise diagnostic interventions when faced with atypical presentations. It further underscores the imperative for obstetricians to possess nuanced expertise in confronting the intricate challenges posed by gestational trophoblastic disease, ensuring optimal maternal and neonatal outcomes.

Prenatal care in the era of economic collapse.

OBJECTIVES: To describe the effect of economic collapse on prenatal care. METHODS: This is an observational study aiming to depict the changes that occur in prenatal care in the case of an economic collapse. Biochemical screening and ultrasound examinations, as well as medical emigration and private-public sector activity, are discussed. RESULTS: Starting October 2019, Lebanon experienced significant and unprecedented economic degradation leading to 81% degradation of the local currency, 85% inflation, and socio-economic suffering, and the situation is currently still deteriorating. The impact on the medical infrastructure has been global and hit all areas. The crisis is multifaceted, varied in the way it played out across public and private sectors, and did not affect them equally. Some were better prepared than others to cope with severe fiscal pressure mainly through the support of non-governmental organizations. All aspects of prenatal care are affected by the crisis. CONCLUSIONS: Given the multiple strains on the Lebanese health care system today, the plight of antenatal care providers needs assistance to ensure adequate follow-up of pregnancies.

Health Literacy Levels and Predictors Among Lebanese Adults Visiting Outpatient Clinics in Beirut.

BACKGROUND: To date, there has been a dearth of research on health literacy in the Eastern Mediterranean Region and in particular Lebanon. OBJECTIVES: This cross-sectional study assessed the levels and correlates of health literacy in Lebanese adults. METHODS: A total of 587 participants (54.5% women) were recruited from the outpatient clinics of five health facilities in Beirut. The questionnaire consisted of the Arabic version of the Functional Health literacy Scale, the Arabic short version of the European Health Literacy Survey, and questions on sociodemographic and health-related factors. Descriptive and inferential statistics were performed to assess the association of these factors with functional health literacy (FHL) and comprehensive health literacy (CHL) levels. KEY RESULTS: About 65.8% had inadequate or problematic FHL and 43.8% had inadequate or problematic CHL. Although FHL was negatively correlated with long-term illness, it was positively correlated with ability to pay and health status. CHL was positively correlated with education, income, ability to pay for treatment, health status, and FHL level, whereas it was negatively correlated with long-term illness. Binary logistic regression showed that low education, low socioeconomic status, and being a widow were predictive of inadequate FHL. Moreover, having inadequate FHL and low income increased the likelihood of having inadequate CHL. CONCLUSION: This study has identified those with risk factors for inadequate health literacy and unfavorable health outcomes. A national action plan can guide the promotion of health literacy and its embeddedness in society to instill competencies and the environment that would eliminate health inequities and sustain health in Lebanon. [HLRP: Health Literacy Research and Practice. 2021;5(4):e295-e309.] Plain Language Summary: This study examined health literacy levels and correlates in 587 Lebanese adults using two recognized screening tools. The first tool measured functional health literacy (FHL), which represents the ability of a person to acquire information on health through reading or writing. The second tool assessed comprehensive health literacy (CHL), which encompasses the ability of a person to use their social skills to acquire health information from different media and make appropriate health decisions based on this information. Close to two-thirds of the participants had inadequate or problematic FHL. More specifically, low education, low socioeconomic status, and widowhood were predictive of inadequate FHL. Nearly one-half of the participants had inadequate or problematic CHL with an increased likelihood of inadequate levels in people with low FHL and low income.