Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.

Self-reported tobacco use is high in the male adult Emirati population (males ~36% vs. females ~3%); however, there are minimal data on tobacco use or exposure to environmental tobacco smoke (ETS) during pregnancy in the United Arab Emirates (UAE). This study investigated the prevalence of, and factors associated with, tobacco use and exposure to environmental tobacco smoke (ETS) amongst pregnant women in the UAE. Baseline cross-sectional data were analysed from the Mutaba’ah Study. Expectant mothers completed a self-administered questionnaire collecting sociodemographic information, maternal tobacco use, and ETS exposure during antenatal visits at three hospitals in Al Ain (UAE; May 2017–February 2021). Amongst 8586 women included in the study, self-reported tobacco use during pregnancy was low (0.7%), paternal tobacco use was high (37.9%), and a third (34.8%) of expectant mothers were exposed to ETS (28.0% at home only). Pregnant women who were employed (adjusted odds ratio (aOR): 1.35, 95% confidence interval (CI): 1.19–1.52), with childbirth anxiety (aOR 1.21, 95% CI 1.08–1.36), and with an increased number of adults living in the same household (aOR 1.02 95% CI 1.01–1.03) were independently more likely to be exposed to ETS. Pregnant women with higher education levels (aOR 0.84, 95% CI 0.75–0.94) and higher gravidity (aOR 0.95, 95% CI 0.92–0.99) were less likely to be exposed to ETS. Public health efforts targeting smoking cessation amongst husbands and promoting smoke-free homes are warranted to help reduce prenatal ETS exposure in the UAE.

Objective To analyse the survival of patients who had undergone bilateral internal thoracic artery grafting versus those with single internal thoracic artery grafting from the available literature. Moreover, this study will review the available literature regarding which of the two techniques seems to be the safest with long-term survival and reduced mortality rates. Methods A literature search of the databases was conducted to retrieve studies that fall under the study design of cohort and randomized controlled clinical trials in English from January 2015 to July 2021. Finally, seven studies were selected: four cohort studies and three other from a randomized trial. Results The cohort studies revealed that bilateral internal thoracic artery grafting is associated with lower mortality rates and better long-term survival outcomes than single internal thoracic artery grafting, while the ART randomized controlled clinical trials showed that there is no significant difference in mortality rates between both the coronary artery bypass grafting techniques. However, all studies concluded that bilateral internal thoracic artery grafting is associated with a higher frequency of deep sternal wound infections. Conclusion The discrepancy in results between the cohort studies and randomized controlled clinical trial remains persistent. However, the stated advantages of bilateral internal thoracic artery grafting are not strong enough to convince surgeons to alter their practice and the wide magnitude of expectations from the ART study was reckoned as inadequate. This may well be due to the presence of limited criteria for bilateral internal thoracic artery grafting in identifying the impact on survival of extended arterial revascularization, and there is a new colossal expectation from the ongoing randomized trial based on multiple arterial grafting versus single arterial grafting.

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The meniscus is a relatively avascular fibrocartilaginous structure that provides a key role in shock absorption and load transmission. However, accurate diagnosis of meniscal retear can present a clinical challenge. The purpose of this study was to conduct a systematic review on the available literature, which compare the sensitivities, specificities, and accuracies of different diagnostic modalities of diagnosing knee meniscal retears in patients who have undergone surgical meniscal repair, such as Magnetic Resonance Imaging (MRI), Magnetic Resonance Arthrography with intraarticular contrast (direct MRA), and a combination of MRI and direct MRA. Two authors independently searched two databases (PubMed and Scopus) for literature related to knee meniscus retear according to the PRISMA guidelines. Four studies were found, which resulted in 291 patients with 293 menisci. All studies were published in 2008 and 2014. In our analysis, we calculated sensitivity to be 78.79% (95% CI, 64.07–93.51), specificity to be 56.58% (95% CI, 20.21–92.94), and overall accuracy to be 66.25% (95% CI, 54.29–78.22) for MRI and sensitivity to be 87.84% (95% CI, 83.93–91.74), specificity to be 88.68% (95% CI, 81.93–95.43), and overall accuracy to be 87.22% (95% CI, 82.22–91.62) for direct MRA. We recommend the use of direct MRA for the diagnosis of meniscal retears due to its higher sensitivity, specificity, and accuracy as compared to MRI and its reduced cost and invasive nature as compared to second-look arthroscopy. However, our review is limited by the number of studies available on this topic. More studies using study designs such as randomized controlled trials, involving MRI, direct MRA, and combinations of such techniques, should be performed to accurately assess the different techniques and aid in designing guidelines to guide the diagnosis of meniscal retears following meniscal repair.