Management of Twin Pregnancy Complications Amid COVID-19: Posterior Colpotomy Approach for Abdominal Cerclage Removal at 18 Weeks Gestation - A Case Report.

BACKGROUND Cervical incompetence and deformities contribute significantly to mid-trimester pregnancy losses and preterm births. Abdominal cerclages prevent these complications, particularly in patients with a history of failed vaginal cerclage or severe cervical deformities. However, pregnancy complications such as chorioamnionitis and fetal demise may necessitate cerclage removal. The removal methods vary, with the least invasive being the colpotomy approach, associated with lower morbidity rates than the transabdominal approach or laparoscopy. CASE REPORT We detail a case involving a 31-year-old woman with a twin pregnancy at 18 weeks gestation, complicated by COVID-19 and chorioamnionitis. This clinical scenario necessitated the removal of an abdominal cerclage. Given the patient's risk profile, a posterior colpotomy approach was deemed most suitable. CONCLUSIONS The posterior colpotomy approach provided an effective and less risky method for abdominal cerclage removal in a high-risk patient. It successfully mitigated the potential complications of general anesthesia and operative risks associated with laparoscopy/laparotomy, offering optimal operative conditions.

Idiopathic Osteosclerosis and Condensing Osteitis in a Sample of the Lebanese Population: A Digital Panoramic Based Study.

Background: Idiopathic osteosclerosis (IO) is an area of enlarged bone production in the jaw that usually appears radiopaque and round, elliptical, or irregular in shape. Condensing osteitis (CO) is a focalized osseous reaction leading to periapical sclerotic bone growth. Objective: The aim of this study was to investigate the prevalence, localization, shape, and dental relationship of IO and CO in a group of Lebanese patients and to correlate these findings to age and gender. Methods: 520 digital panoramic radiographs of patients (215 men and 305 women) ranging in age from 18 to 77 (mean age 40.89 years) who visited the Faculty of Dental Medicine, Lebanese University, for dental treatment were included in this study and assessed for IO and CO. The prevalence of the two lesions according to gender and age, as well as their localization, and dental relationship, were recorded and saved in an Excel sheet. Results: Among the 520 radiographs, 47 (9%) showed IO, and 30 (5.8%) showed CO. Both lesions are more frequent among females in their third decade and are essentially found in the mandible, mainly in relation to the root apices. Conclusion: Within the limits of this study, we concluded that in our sample of the Lebanese population, the prevalence of IO and CO is low and supports the theory that IO can be defined as developmental variations of normal bony architecture unrelated to a local stimulant, and CO could be considered reactive bone formations related to pulpitis, deep restoration, or caries.

Bone Apposition in the Mandibular Angle in Adult Patients Diagnosed with Bruxism: a Digital Panoramic Based Study.

Background: Bruxism is defined as a movement disorder of the masticatory system leading to serious problem in the integrity of the oral dentition; it is characterized by teeth grinding and clenching and has been typically classified into three types: a) bruxism occurring during sleep, b) awake-related bruxism, and c) mixed sleep/awake-related bruxism. Objective: The aim of this study was to assess any bone apposition in the mandibular angle in a group of adult patients diagnosed with bruxism using digital panoramic radiographs. Methods: In the sample of 150 digital panoramic radiographs of 66 women and 84 men with an age range of 24-78 years and diagnosed with bruxism were evaluated. Results: Among the 300 mandibular angles evaluated, 156 (52%) showed bone apposition against 144 (48%) who did not. Conclusion: The changes in the mandibular angle, especially bone apposition, can help diagnosing long term bruxism on panoramic radiographs.

Mapping Maxillary Sinus Septa in a Lebanese Sample: a Radio-anatomical Study.

INTRODUCTION: Sinus septa are bony processes that develop in a variable fashion. Such structures present a challenge for surgical procedures of the maxillary sinuses. AIM: This study aims to evaluate the prevalence and patterns of maxillary sinus septa in a sample from the Lebanese population. METHODS: A retrospective cross-sectional study was conducted on a series of 568 Cone Beam Computed Tomography scans (CBCT) belonging to patients that presented to the Maxillofacial Radiology division of the Faculty of Dental Medicine in the Lebanese University. None of the included patients had sinus pathologies. Age ranged from 18 to 80 years with 332 females and 236 males yielding a total of 1136 maxillary sinus. Sinuses were inspected for septa, specifying their location in multiple dimensions, angulations and number. RESULTS: 36.27% of studied patients presented at least one septum (27.46% of all sinuses). No predilection towards age or sex was found. A higher number of septa were located in the middle region anteroposteriorly (38.14%), and most were localized in the inferior third coronally (81.16%). Multiple angulations are also reported. CONCLUSION: Our results suggest a common prevalence of maxillary sinus septa in our Lebanese sample and suggest similar distribution and patterns to that of reported literature.

New automated antimüllerian hormone assays are more reliable than the manual assay in patients with reduced antral follicle count.

OBJECTIVE: To compare the strength of the relationship between antral follicle count (AFC) and serum antimüllerian hormone (AMH) concentrations obtained with two automated and one manual AMH assays in three different AFC populations. DESIGN: Prospective cohort study. SETTING: University-affiliated IVF-ET center. PATIENT(S): Frozen-thawed serum samples of 211 assisted conception candidates, aged 24-43 years. INTERVENTION(S): Serum AMH was measured using one manual (AMH Gen II) and two fully automated (Access AMH and Elecsys AMH) assays. Antral follicle count was performed under strictly standardized conditions and sorted into three groups according to tercile values: low AFC (3-12 follicles; n = 73), intermediate AFC (13-20 follicles; n = 65), and high AFC (21-84 follicles; n = 73). MAIN OUTCOME MEASURE(S): Strength of correlation between AMH levels and AFC. RESULT(S): Overall, AMH levels were lower with Access AMH (-16%) and Elecsys AMH (-20%) than with AMH Gen II. Remarkably, the strength of correlations between AFC and circulating AMH levels was the same with the three assays (r = 0.83). Yet in the low AFC group, serum AMH levels obtained by Access AMH and Elecsys AMH showed a stronger correlation with AFC (r = 0.63 and r = 0.65, respectively) than the AMH Gen II (r = 0.52), a phenomenon that was not observed in the remaining AFC groups. CONCLUSION(S): As compared with conventional AMH Gen II assay results, [1] serum AMH concentrations were -16% and -20% lower with Access AMH and Elecsys AMH, respectively; and [2] automated assays were more strongly correlated to AFC in the subset of patients with reduced follicle count.

Steroid hormone pretreatments in assisted reproductive technology.

Adequate availability and FSH sensitivity of ovarian antral follicles and coordination of their growth during controlled ovarian hyperstimulation (COH) rank among factors that may determine outcome, particularly in patients presenting ovarian function defects and so-called "poor responders." Growing evidence indicates that both factors are positively influenced by steroid hormone pretreatments. First, data from studies conducted in both animals and in women exposed to virilizing androgen doses indicate that androgen pretreatments may increase follicle responsiveness to FSH and/or the number of growing follicles in the ovary, thereby constituting an interesting perspective in the management of "poor responders." Second, overcoming pre-COH heterogeneities in antral follicle sizes, which are more pronounced in "poor responders," to achieve adequate coordination of multiple follicular growth during COH also is contributive. For this, suppression or attenuation of the premature FSH increase during the preceding late luteal phase using sex steroid pretreatments (oral contraceptives, synthetic progestogens, or estradiol), or additional strategies such as premenstrual GnRH antagonist administration has been shown to be effective. The present paper will critically review proposed mechanisms and clinical results of sex steroid hormone pretreatments in these two different indications as an effort to optimizing COH outcome.