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Ihab Usta

Publications and source records attributed to Ihab Usta.

7 recordsLinked to original sources
PubMed2004

Thrombotic thrombocytopenic purpura and pregnancy: report of four cases and literature review.

Thrombotic thrombocytopenic purpura (TTP) is a severe life-threatening hematological disorder affecting the microcirculation of multiple organ systems. Infection, pregnancy, cancer, drugs, and surgery are frequently associated with the initial episodes and relapses. Women who are either pregnant or in the postpartum period make up 10-25% of TTP patients, suggesting the interrelationship between TTP and pregnancy. The introduction of aggressive treatment with plasma transfusion and plasmapheresis has improved maternal and fetal survival rates. We report four cases of pregnancy-related TTP, describing the clinical course of patients, including response to therapy and pregnancy outcomes. Three out of four (75%) patients were treated by daily single session of plasmapheresis for a period ranged between 3 and 23 days. One patient had complete response to treatment with no sequelae, the second patient had resistant disease and died due to multiorgan failure, while the third patient had complete response after 2 episodes of TTP, which was complicated by intrauterine fetal growth retardation and death. Review of the previously reported cases of pregnancy-related TTP and the current treatment options for this rare condition are discussed also.

Adult↗
PubMed2003

Postpartum splenic rupture.

BACKGROUND: Spontaneous splenic rupture in pregnancy is rare and occurs most commonly in the third trimester or puerperium. CASES: In the first case, an eclamptic woman had postpartum uterine atony that necessitated hysterectomy. She was reexplored for increasing abdominal girth and evidence of hemoperitoneum on computed tomography scan. An actively bleeding defect was noted in the spleen, necessitating splenectomy. In the second case, a patient with cholestasis of pregnancy developed persistent bleeding after manual removal of the placenta, requiring a suction curettage followed by hysterectomy. Reexploration because of a dropping hematocrit revealed a capsular defect on the spleen, for which splenectomy was performed. CONCLUSION: A high index of suspicion of postpartum splenic rupture is imperative because delay in the diagnosis can lead to catastrophic consequences. Thus, it is vital to evaluate the entire abdomen in posthysterectomy hemoperitoneum.

Adult↗
PubMed2003

Caesarean route of delivery and hyaline membrane disease: a hospital-based case-control study in Greater Beirut.

A hospital-based case-control study was conducted to examine the relationship between hyaline membrane disease (HMD) and caesarean route of delivery, in light of sociodemographic, obstetric and perinatal confounders and risk modifying factors. The study population consisted of 78 HMD cases and a control group of 803 infants delivered at 25-36 weeks' gestation and admitted over a 16-month period to nine hospitals in Greater Beirut, Lebanon. The likelihood of delivery by caesarean section was nearly twice as high among newborn infants diagnosed with HMD as compared with the non-HMD control group (OR = 2.02, [95% CI 1.04, 3.92], after adjusting for fetal growth ratio, one-minute Apgar score, maternal age, antenatal steroid administration and pregnancy-related complications. The impact of caesarean section on HMD was considerably more important in infants delivered < or = 32 weeks' gestation (OR = 2.10, [95% CI 0.79, 5.52]) as compared with those delivered afterwards (OR = 1.13, [95% CI 0.40, 3.21]).

Adult↗
PubMed2003

Gastrointestinal malformations in two infants born to women with hyperthyroidism untreated in the first trimester.

We report two infants with gastrointestinal anomalies: one with esophageal atresia and tracheo-esophageal fistula and the other with biliary tree atresia, born to hyperthyroid women diagnosed and treated with methimazole after 14 weeks' gestation. Euthyroidism was documented in both infants. These cases raise the issue of whether untreated hyperthyroidism and not methimazole intake is the teratogen.

Abnormalities, Multiple↗
PubMed2002

Primary infertility associated with isolated cervical collecting diverticulum.

OBJECTIVE: To describe a previously unreported isolated congenital cervical diverticulum and its gynecologic, reproductive, and obstetrical implications. DESIGN: Case report. SETTING: A university hospital. PATIENT: A 31-year-old woman presenting with menometrorrhagia and primary infertility. Investigation revealed an isolated collecting cervical diverticulum causing prolonged postmenstrual spotting, possibly interfering with sperm capacitation and access to the uterine cavity. INTERVENTION(S): The examination included hysterosalpingography and magnetic resonance imaging. The combined hysteroscopy and laparoscopy revealed a 5 x 5 cm cervical diverticulum, around 1 cm from the external cervical os, leading to a short cervical canal connected to a normal uterine cavity. The patient achieved a pregnancy after controlled ovarian hyperstimulation and ultrasonographically guided intrauterine insemination. MAIN OTUCOME MEASURE(S): Pregnancy and obstetrical outcome. RESULT(S): Extensive evaluation revealed the patient's condition to be a previously undescribed congenital cervical anomaly. The patient's infertility was corrected by ovulation induction and sonographically guided intrauterine insemination, which resulted in a twin pregnancy. After 27 weeks of gestation, preterm labor complicated the delivery. CONCLUSION(S): The diagnosis and management of this unusual congenital cervical diverticulum present a particular challenge, as this congenital abnormality has not been previously described or reported.

Adult↗