GIT Surgery
Samir Johna
Abstract
This editorial focuses on the importance of the clinical diagnosis in clinical practice. While huge leaps are made in laboratory testing and imaging, physical examination remains a corner stone in medical practice allowing high quality care delivery with reasonable costs.
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This editorial focuses on the importance of the clinical diagnosis in clinical practice. While huge leaps are made in laboratory testing and imaging, physical examination remains a corner stone in medical practice allowing high quality care delivery with reasonable costs.
surgery
Hayder Al khaqani; Ali Abbas Alshawi
Abstract
Background: Mandibular fracture is one of the commonest facial skeletal injuries, the classical treatment for condylar fracture either by close or open reduction. The purpose of this study is to prove the effectiveness of early functional rehabilitation through the effect of neuromuscular adaptation ...
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Background: Mandibular fracture is one of the commonest facial skeletal injuries, the classical treatment for condylar fracture either by close or open reduction. The purpose of this study is to prove the effectiveness of early functional rehabilitation through the effect of neuromuscular adaptation in unilateral and bilateral condylar fractures .
Patients and Methods: A prospective study included thirty patients presenting with condylar fractures, divided into three age groups , group I children less than 12 years old , group II teenagers age range 12-17 years old and group III adult more than 17 years those admitted to maxillofacial department in Al-Basra Teaching Hospital from May,1,2015 until October,30,2016 presented with a malocclusion, a deviated midline, and a limited mouth opening. Computed Tomography is done as early as possible. The method used in our study was the early closed active functional treatment.
Results: Young patients less than 12 years of age were 17 (56.7%), also we found that the dislocation of condylar head fracture was more common in the very young age group according to the CT- Scan. Teenagers patients (12-17) years of age were 2 (6.7%) while adult patients more than 17 years old were 11 (36.7%) .
Conclusion: The complete condylar remodeling (restitution of condylar head) occurs in very young age group (less than 12 years old) and to less extent in others age groups , the diagnosis depend on ct scan findings in pre and post imaging .
surgery
Thoulfokar Shokor Alsaadi; Ahmed Fadhel Al-Quisi
Abstract
Purpose: To assess the efficacy of advanced platelet-rich fibrin (A-PRF) and 1% hyaluronic acid gel (HA ) as a regenerative biomaterial for wound healing after impacted third molar extractions.Materials and methods: This study was a randomized controlled trial carried out in the oral surgery unit of ...
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Purpose: To assess the efficacy of advanced platelet-rich fibrin (A-PRF) and 1% hyaluronic acid gel (HA ) as a regenerative biomaterial for wound healing after impacted third molar extractions.Materials and methods: This study was a randomized controlled trial carried out in the oral surgery unit of the dental teaching hospital. Furthermore, the participants were randomly assigned into three different groups. The patient's surgical site was left without adding any material in group A. While in group B (study group), the patient's surgical site was treated by applying a mixture of 1 cc HA gel with a one gel foam sponge. In group C (study group), the surgical site was treated by placing an A-PRF clot inside the surgical site. The first follow-up visit was 24 hours after the surgery to assess the soft tissue healing, with subsequent assessment visits on the third and seventh postoperative days.Results: Hyaluronic acid and A-PRF groups, when compared with the control group, showed significant improvement in early wound healing scores. However, the A-PRF group had a statistically significant improvement over the hyaluronic acid group only during the first and third postoperative days.Conclusion: Hyaluronic acid gel and A-PRF effectively enhanced early soft tissue healing following the surgical removal of the impacted lower third molar with the upper hand for the A-PRF in the 1st and the 3rd postoperative days disappears in the 7th day.Thus, the ease of availability of the Hyaluronic acid gel makes it an attractive alternative to the A-PRF.
Dentistry
ahmed ali al-marashi
Abstract
Background:The study aims to present the location and course of the posterior superior alveolar artery (PSAA) using cone beam computed tomography (C.B.C.T.) imaging, which is considered as a valuable part for treatment planning in sinus augmentation procedures for dental implant treatment.Materials and ...
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Background:The study aims to present the location and course of the posterior superior alveolar artery (PSAA) using cone beam computed tomography (C.B.C.T.) imaging, which is considered as a valuable part for treatment planning in sinus augmentation procedures for dental implant treatment.Materials and Methods: Data was extracted from included C.B.C.T. images using implant planning software and entered on Microsoft Excel and SPSS for statistical analysis. For each radiograph measurements were taken on premolar and molar region to determine the location of PSAA as being extraosseous or intraosseous. The distance of the artery from the floor of the sinus was also measured.Results: The study included 56 radiographic images. 44 view of right and left maxillary sinus satisfied the inclusion criteria. Each sinus had 2 points of measurements, giving total of 176 sites. The average distance of PSAA was 11.1 from the floor of the maxillary sinus and the median was 10.5mm. The PSAA was extraosseous in most instances with 57% of the total sample.Conclusions: The location of the PSAA can be mostly in extraosseous site. The artery might also move from extraosseous to intraosseous location, or Vise versa, during its course as it travel from the molar to premolar area. Correct identification during planning of sinus lift procedures can help in avoiding accidental trauma during surgery.
Urosurgery
ERSHAD HUSSAIN GALETI; Saqib Shahab; Mriganka Deuri Bharali; Gousia Begum Sowdagar
Abstract
Background: Infection is one of the major complications in endourological procedures, and may range in severity from mild fever to septic shock. A survey on postoperative antibiotic usage showed varied usage. No clear guidelines exist for the same.The objective of this study is to rationalise the usage ...
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Background: Infection is one of the major complications in endourological procedures, and may range in severity from mild fever to septic shock. A survey on postoperative antibiotic usage showed varied usage. No clear guidelines exist for the same.The objective of this study is to rationalise the usage of post-operative antibiotics in urine culture negative patients with symptomatic upper urinary tract calculi.Materials and Methods: A prospective randomised controlled study done from March 2021 to February 2022. A total of 250 cases operated for upper urinary tract calculi at our institution with sterile urine culture are considered. All the patients received only single dose of prophylactic antibiotic before surgery and no postoperative antibiotics were given. They were divided into 2 groups to assess the local antibiotic (gentamycin) implications in reducing the usage of post-operative antibiotics. Postoperatively fever was assessed along with other signs of infection like pyelonephritis, symptomatic urinary tract infection (UTI) and sepsis. Statistical analysis is done and p value <0.05 is considered significant.Results: A total of 19 patients (8%) developed fever among 250 patients. Among the 124 Percutaneous Nephrolithotomy (PCNL) patients, 11 developed fever and among 126 Ureterorenoscopic lithotripsy (URSL) patients, 8 developed fever. Overall fever incidence is similar with gentamycin (7.5%) or standard normal saline (NS) irrigation (7.7%). None of the patients developed pyelonephritis, UTI or sepsis.Conclusion: Single dose of pre-operative intravenous (IV) antibiotic is sufficient for upper tract urolithiasis procedures. There is no significant role of local antibiotic instillation in irrigation fluid, on the post-operative infections.
Anaesthesia and Intensive Care
Singam Geetha; Noor Ul Ain Fatima; Akhya Kumar Kar; Soujanya Rani; Padmaja Durga; Lakshmi Brahmaramba
Abstract
Introduction:COVID-19 infection has been implicated in millions of deaths worldwide. The respiratory distress occurs with cytokine storm around 2ndweek of symptom onset. Tocilizumab, a humanized monoclonal antibody directed against the interleukin 6(IL-6) receptor has been used at varying extents in ...
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Introduction:COVID-19 infection has been implicated in millions of deaths worldwide. The respiratory distress occurs with cytokine storm around 2ndweek of symptom onset. Tocilizumab, a humanized monoclonal antibody directed against the interleukin 6(IL-6) receptor has been used at varying extents in suppressing it, however, limited literature exists about the timing of its administration. We contemplated this study with the primary objective to establish whether tocilizumab favourably affected the outcome when given in the early stages of complication. The secondary objectives were to assess the importance of ROX score and the effect of age on outcome. Methods:We conducted a retrospective study in a tertiary care hospital. Patients who received tocilizumab were divided into two groups depending on whether they received the drug in ≤ 10 days (Group 1) or≥ 11 days (Group 2) of onset of symptoms. The patient’s demographic data and co-morbidities, on- admission vitals, ROX score, and laboratory parameters, outcome etc. were collected from the electronic health records.Results:Both groups were comparable with regard to demographic and baseline parameters on admission. The outcome was significantly better in patients of Group-1(P=0.01) with better survival. The outcome was also significantly higher in ages ≤ 50yrs age(P=0.02) who received tocilizumab. Failure to improve ROX score after 24hrs. of administration of tocilizumab was associated with poor outcomes (p=0.001).Conclusion: Tocilizumab when given in the early stages of COVID-19-related complications may be associated with decreasing mortality. Age may be an indicator of favourable effect, and failure to improve ROX score after tocilizumab is associated with poor outcomes
Dentistry
Muthana Samir; Suzan Ali
Abstract
Background: Periodontitis is universally agreed to be an inflammatory disease that arises as a consequence of the interaction between periodontal pathogens and the host’s immune response, oxidative stress might be one of the most significant contributors to the development and progression of periodontitis. ...
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Background: Periodontitis is universally agreed to be an inflammatory disease that arises as a consequence of the interaction between periodontal pathogens and the host’s immune response, oxidative stress might be one of the most significant contributors to the development and progression of periodontitis. One of the most significant markers of oxidative stress is a molecule called 8-OHdG.Aim of the study: Analyzing the levels of 8-OHdG in saliva of periodontitis/obese patients in comparison to healthy controls with analysis of its correlation with various clinical periodontal parameters.Materials and methods: 110 subjects (30 obese, 30 periodontitis, 30 obese periodontitis and 20 healthy subjects) took part in the study. Salivary samples were obtained from all subjects prior to clinical examination. Full periodontal examination was conducted for each participant which entailed plaque index PLI, bleeding on probing BOP, probing pocket depth PPD and clinical attachment loss CAL. Obesity was assessed by using body mass index BMI.Results: It was showed that periodontitis patients and obese patients had significantly elevated concentrations of salivary 8-OHdG when compared with healthy subjects. Also these levels correlated positively with CAL in obese periodontitis patients.Conclusions: This study revealed an association between 8-OHdG and periodontitis which suggests that this biomarker plays some part in the pathogenesis of periodontal disease. Moreover, this study showed an association between this biomarker and obesity measures, which suggests that periodontitis and obesity are interconnected via oxidative stress.
Urosurgery
ERSHAD HUSSAIN GALETI; Pogula Vedamurthy Reddy; Gousia Begum Sowdagar
Abstract
BACKGROUND: Female urethral strictures are rare; that is why the literature describing stricture management in women is sparse. We describe the outcomes and complications of dorsal buccal mucosa graft urethroplasty done in female patients with urethral stricture.METHODS: From January 2017 to December ...
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BACKGROUND: Female urethral strictures are rare; that is why the literature describing stricture management in women is sparse. We describe the outcomes and complications of dorsal buccal mucosa graft urethroplasty done in female patients with urethral stricture.METHODS: From January 2017 to December 2019, 25 women 33 to 65 years old with urethral stricture disease underwent urethral reconstruction using a dorsal onlay buccal mucosa graft. Patients were diagnosed with Uroflowmetry (Qmax) and micturating cystourethrography. A urodynamic study was done to rule out bladder pathology. Follow up UFR was done every three months after catheter removal for one year after that every six months. RESULTS: The mean age of the patients was 52.48 years. Mean stricture length was 1.9 cm. Preoperative versus postoperative mean Q max was 6.7 ml/s versus 19.6 ml/s.Most cases of UFR after catheter removal showed a Qmax >15ml/hr. Three patients complained of poor flow after three months of catheter removal, which were managed with urethral dilation twice a week and their strictures were stabilized after six months.CONCLUSION: The dorsal approach with buccal mucosa graft allowed us to reconstruct an adequate urethra in females with good outcomes.
Sarah Ali Darweesh; Jasim M. Al-Diab; Sawsan S. Al-Harron; Hussam Aziz Hasson
Abstract
Papillary thyroid carcinoma is the most common endocrine and thyroid malignancy. The (BRAF V600E) mutation is the most common mutation in papillary thyroid cancer (PTC). The mutation is detected in about (60%) of the cases. Patients with BRAF mutation have been linked to aggressive clinical behavior, ...
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Papillary thyroid carcinoma is the most common endocrine and thyroid malignancy. The (BRAF V600E) mutation is the most common mutation in papillary thyroid cancer (PTC). The mutation is detected in about (60%) of the cases. Patients with BRAF mutation have been linked to aggressive clinical behavior, high recurrence rate, metastasis, and failure of treatment.
surgery
Mazin A. Abdulla; Abdulsattar Ali Abdulsattar; Hussein Azher Hadi; Shahad Ali Mahamood; Hawraa Ali Raheem; Nabaa Jawad Ramadan
Abstract
Background: Appendicitis is a common surgical emergency with a global incidence of approximately 233 per 100,000 population. The incidence is higher in males than in females, and it varies across seasons and countries. This study aims to throw light on the pattern of appendicitis in Basrah. IraqMethods:This ...
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Background: Appendicitis is a common surgical emergency with a global incidence of approximately 233 per 100,000 population. The incidence is higher in males than in females, and it varies across seasons and countries. This study aims to throw light on the pattern of appendicitis in Basrah. IraqMethods:This is a retrospective analysis of all available data in Basrah Teaching Hospital for the last 10 years covering the period from January 1999 to December 2008. The total number of hospital admissions for each year was obtained in addition to age, gender and month of admission for all the cases of appendicitis were recorded. Tables and figures were drawn and an analysis was done, using simple Chi square test, and P value as found appropriate.Results:There were 5412 patient underwent Appendectomy with M: F ratio as 3.4: 1. The overall mean age was 24.3 years. The highest incidence was in April, May, June, and July with a peak level in December. Ramadan (the fasting month) showed a significant increase in incidence of appendicitis Conclusion: There is an increase incidence of acute appendicitis over the years with more prevalence in males and more common in the second decade of life for both males and females, also the incidence was higher in summer moths and in Ramadan.
neurosurgery
Thikra Abdul jebbar Hussein
Abstract
Background: The most powerful independent prognostic variables were GCS and CT characteristics. Since the introduction of CT imaging, the treatment of patients with head injury has improved considerably and it has become a powerful prognostic tool for improving clinical care in TBI, significantly reducing ...
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Background: The most powerful independent prognostic variables were GCS and CT characteristics. Since the introduction of CT imaging, the treatment of patients with head injury has improved considerably and it has become a powerful prognostic tool for improving clinical care in TBI, significantly reducing both morbidity and mortality.Aim of study: To assess the validity of Glasgow Coma Scale and brain computed tomography scan together in predicting outcome of patients presented with traumatic brain injury at emergency department.Patients and methods: A prospective follow up study carried out in Emergency Department of Baghdad Teaching Hospital in Baghdad Medical city for period from 1st of October, 2015 to 30th of September, 2016 on convenient sample of 244 patients with traumatic brain injury. The diagnosis of traumatic brain injury was based on New Orleans Criteria and Canadian Diagnostic Rules and confirmed by Neurosurgery physician. Glasgow coma scale was measured by researcher and interpretation of Glasgow coma scale was done by both researcher and Neurosurgery physician according to Glasgow Coma Score and computerized tomography scan was interpreted by Radiologist.Results: The validity results of Glasgow coma scale regarding traumatic brain injury patients' outcome were sensitivity (100%) and specificity (58.9%), while validity results of computerized tomography scan findings regarding traumatic brain injury patients' outcome were sensitivity (66.6%) and specificity (93.6%). The validity results of Glasgow coma scale findings regarding traumatic brain injury patients' morbidity were sensitivity (70.5%) and specificity (99%), while validity results of computerized tomography scan findings regarding traumatic brain injury patients' morbidity were sensitivity (77.7%) and specificity (99%).Conclusions: The use of both Glasgow coma scale and computerized tomography scan emergency department had valuable results in prediction of morbidity for patients with traumatic brain injury while have no effect for prediction of mortality.
surgery
Jasim Dager Saud; Muataz Fathullh Fadhil
Abstract
Background:Lichtenstein in the 1980, employed a mesh piece to the inguinal canal`s floor. It showed superior results compared to previous tissue-based repairs. It is gold standard for open hernia repair with recurrence rate at 5 years <4%, with risk of severe chronic pain at 3 years = 6%. The Chastan ...
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Background:Lichtenstein in the 1980, employed a mesh piece to the inguinal canal`s floor. It showed superior results compared to previous tissue-based repairs. It is gold standard for open hernia repair with recurrence rate at 5 years <4%, with risk of severe chronic pain at 3 years = 6%. The Chastan technique, in 2005, was developed to improve the Lichtenstein technique. He was using different dissection and different mesh implantation (small grips covering whole of one side of mesh to secure immediate fixation around the cord with a self-gripping flap). Here in Basrah in 2016, we try to improve the Lichtenstein technique by using the same dissection of Chastan but differ from Chastan in applying of mesh. We used polypropylene mesh in three techniques.ObjectiveA comparative assessment of operative time, early and late postoperative complications of surgery for inguinal hernia repair using lichteinstien, Chastan and Basrah techniques.Methods:Between December 2016 and December 2019, a total of 150 male adult patients with primary inguinal hernia were included according to inclusion criteria of our study. Patients were divided into 3 groups each group contain 50 patients which undergo Lichteinstien (L), Chastan(C) and Basrah(B) techniques respectively: All patients followed up to two years. The operative time, early and late postoperative complication were compared among three groups.Result:The 3 groups were similar in terms of age, sex, comorbidities, BMI, ASA classification, types of inguinal hernia (Nyhus classification). There is no significate difference in terms of operative time (p value=0.954),24-h VAS score, length of hospital stays (LOS) and return to work (RTW), (p value=0.607,0.206,0.651 respectively). Seroma formation, chronic pain and recurrence rate were lower in Basrah and Chastan than Lichtenstein.Conclusion: Basrah and Chastan techniques show better results than Lichtenstein technique in terms of chronic pain, seroma formation and recurrence rate.
Urosurgery
Vishnuvardan Reddy N; Charan Kumar G.V.; Devaraj Rahul; DHEERAJ SSS; Ram Reddy Ch
Abstract
Background: This study evaluated the accuracy of the R.I.R.S scoring system (kidney stone density, inferior pole stones, stone burden, and renal infundibular length) in predicting the stone-free rate (SFR) post RIRS. Methods: This retrospective study was conducted in 50 patients aged 18-65 years undergoing ...
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Background: This study evaluated the accuracy of the R.I.R.S scoring system (kidney stone density, inferior pole stones, stone burden, and renal infundibular length) in predicting the stone-free rate (SFR) post RIRS. Methods: This retrospective study was conducted in 50 patients aged 18-65 years undergoing RIRS for kidney stones in a tertiary institute hospital from February 2022 to June 2023. Medical records were analysed to obtain the the pre-operative investigations, intra-operative findings and post-operative complications and follow up data. The RIRS parameters were also measured to predict stone free rate post RIRS. Results: 38% patients had mild RIRS score (4-5), 60% patients had moderate RIRS score (6-8) and 2% patients had severe RIRS score (9-10). 46 patients (92%) had stone free (SF) status while remaining 4 patients (8%) had residual stone fragments. 22% patients had complications such as fever (18% patients) and urosepsis (4% patients). AUROC for stone burden (mm) and stone density (HU) predicting SF status was 0.989 (p = 0.001) and 0.837 (p = 0.028) respectively. AUROC) for R.I.R.S. Score predicting Complications was 0.8 (p = 0.002) statistically significant. Conclusion: R.I.R.S. scoring system was statistically significant in assessing stone free rate and complications. The higher R.I.R.S. score was associated with more residual stone fragments, lower stone clearance and higher postop complications. Hence R.I.R.S is a reliable and accurate preoperative tool for estimating the probability of stone-free state and complications after RIRS surgery.