Print ISSN: 1683-3589

Online ISSN: 2409-501X

Keywords : NON


THE PROFILE OF PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL TRACT BLEEDING IN BASRAH TEACHING HOSPITAL

Basrah Journal of Surgery, Volume 24, Issue 2, Pages 39-45
DOI: 10.33762/bsurg.2018.160088

Abstract
Upper gastrointestinal tract bleeding is a common emergency and life threatening condition. During the last three decades, many factors have been evolved that might change the incidence, age of presentation, site of bleeding and the outcome of patients with non variceal upper gastrointestinal tract bleeding.
This study aimed to assess the profile and the mode of presentation of the patients with non-variceal upper gastrointestinal tract bleeding and to assess the etiology and the effect of different factors (demographic, mode of presentation and the treatment options) on the patient's outcome.
This observational prospective study was carried out from May 2008 to October 2014 in Basrah Teaching Hospital. All adult patients who were presented with non-variceal upper gastrointestinal tract bleeding were included. All the demographic, clinical and treatment modalities in addition to the mortality rate and complications data were collected and analyzed.
A total of 238 patients with non-variceal upper gastrointestinal tract bleeding were included in this study, 161 (67.6 %) patients were males and 77 (32.3 %) were females. The mean age was 50.62±17.06. Hematemesis was the commonest presentation in 125 (52.5%) followed by melena in 81 (34.03%). Duodenal ulcer was the commonest cause in 99 (41.59%) patients followed by erosive gastritis in 37 (15.5%) patients. The most common treatment modality was the medical treatment used in 186 (78.15%) patients which was successful in 179 (96.23%) with relatively low complications and rebleeding rates. Interventional endoscopy was used for 40 (16.8%) and was successful in 38 (95%) with 2 (5%) patients developed rebleeding. Surgery was done for 12 (5.04%) patients and was successful in 8(66.6%) and it was associated with highest rate of mortality (33.3%). Concerning the factors that might affect the outcome, there was a statistically significant effect of mode of treatment (odd ratio 6.42, p=0.03) and smoking (odd ratio 5.86, p=0.047) on the rate of development of complications. The mode of treatment had a statistically significant effect on mortality rate (odd ratio 20.24 p=0.001). The use of aspirin and/or NSAID affects significantly the rebleeding rate (odd ratio 7.4 p=0.025).
In conclusion, the profile of our patients with non-variceal upper gastrointestinal tract bleeding was not greatly different from that of surrounding Middle East countries. We found that peptic ulcer disease was the commonest cause for which medical treatment was the most successful mode of treatment. Among many known risk factors, the mode of treatment and smoking were the factors that increase the complication rate. The mode of treatment was the only factor that affects the mortality rate. Use of aspirin or non-steroidal anti-inflammatory drugs influenced the rebleeding rate.

EVALUATION OF THE EFFECT OF SECOND DOSE OF SUCCINYLCHOLINE ON THE PULSE RATE IN NON-ATROPINISED PATIENTS UNDER GENERAL ANESTHESIA

Abrar A Abdul-Salam; Jasim M Salman; Salam N Asfar

Basrah Journal of Surgery, Volume 23, Issue 1, Pages 3-7
DOI: 10.33762/bsurg.2017.132405

Abrar A Abdul-Salam*, Jasim M Salman@ & Salam N Asfar#
*MB, ChB, FICMS Anesthesiology, Al-Sadir Teaching Hospital, Basrah. @MB, ChB, DA, FICMS, Assistant Professor of Anesthesiology, Basrah College of Medicine. #MB, ChB, MSc, Professor of Anesthesiology, University of Basrah, College of Medicine, Basrah, IRAQ.

Abstract
From the time when succinylcholine(scoline) introduced to clinical anesthesia, intravenous route of administration of the drug has been broadly practiced. Severe bradycardia and arrhythmias may from time to time produced by single or frequent doses. The mechanism of bradycardia caused by succinylcholine administration has not been completely explained, it has been found that succinylcholine produce a unpredictable effects on the sinoatrial node. In our hospital , a second dose of succinylcholine is usually used for short surgical procedures that required good relaxation like anorectal surgery and orthopedic manipulation under anesthesia.
This study aimed to discuss the conditions under which bradycardia appear during general anesthesia with oxygen, propofol, scoline, halothane, along with the use of second dose of scoline and assess the need for atropine to prevent this effect.
Fifty patients aged between 20-50 years of American Society of Anesthesiologists (ASA) class I were included in this study, anesthesia was induced with propofol, scoline, along with oxygen halothane mixture, then 2nd dose of scoline was given 10 minutes later. Frequent pulse rate were recorded.
There was considerable decrease in pulse rate of the patients after the 2nd dose of succinylcholine, 36% of the patients developed bradycardia (pulse rate below 60), and the mean reduction in pulse rate was (23±13 beats/min). However there is no need for the use of atropine since all of the patients return to normal rates (60-100 beats/min) within 1 minute spontaneously.
Conclusion: It has been found that the use of scoline in one dose produce decrease in pulse rate but not reach to the bradycardia level, while the uses of another dose will result in significant reduction in pulse rate that can reach to the level of bradycardia. All patients return to normal level of pulse rate within 1 minute, therefore, there is no need to use atropine neither preoperatively nor after developing of bradycardia since it's a self limiting phenomenon.

IMMUNOHISTOCHEMICAL EXPRESSION OF STEM CELL MARKERS CD44, CD166 AND ALDH1A1 IN NON-NEOPLASTIC POLYPS OF THE COLON IN SAMPLE OF IRAQI PATIENTS

Basim Sh Ahmed; Mustafa M Ibraheem; Nawal M Abdullah

Basrah Journal of Surgery, Volume 23, Issue 1, Pages 37-44
DOI: 10.33762/bsurg.2017.132421

IMMUNOHISTOCHEMICAL EXPRESSION OF STEM CELL MARKERS CD44, CD166 AND ALDH1A1 IN NON-NEOPLASTIC POLYPS OF THE COLON IN SAMPLE OF IRAQI PATIENTS

Nawal M Abdullah*, Mustafa M Ibraheem@ & Basim Sh Ahmed#

*MB,ChB, MSc, Assist. Prof., Department of Anatomy, College of Medicine, University of Basrah. @MB,ChB, MSc, PhD, Assist. Prof., Department of Anatomy, College of Medicine, University of Al-Mustansiryah. #MB,ChB, FICMS, Assist. Prof. Department of Pathology, College of Medicine, University of Al-Mustansiryah, IRAQ.

Abstract
The aim of this retrospective study on tissue specimens of benign colorectal polyps is to evaluate the significance of IHC markers CD44, CD 166 and ALDH1A1 expression in non-neoplastic (Juvenile and Hamartomatous) polyps and their association with different clinicopathological parameters & to compare their expression in benign polyps with that of normal colonic tissue .
Seventy cases enrolled in the study including benign polyps (juvenile & hamartomous polyps) & benign looking colonic tissue obtained from archive of histopathology unit in Gastroenterology and Hepatology hospital in Baghdad Medical City and histopathology unit in Al-Sadder Teaching Hospital in Basrah city for the period Sept. 2015 to Dec. 2016. Four micrometer sections were obtained from formalin fixed paraffin-embedded blocks treated IHC with CD44, CD166 and ALDH1A1 tumor markers.
Majority of polyps were juvenile, no difference regarding gender distribution. The common location was rectum/rectosigmoidal region. CD166, CD44 and ALDH1A1 showed high expression regarding age, gender and location in benign tumors when compared with healthy looking tissue.
In conclusion, colorectal polyps are critical clinical entity and many of them are a precursors to malignant diseases so colonoscopy is essential screening test, polypectomy and follow up is mandatory for patients with colorectal polyps even if they are benign.

EVALUATION OF THE EFFECT OF OCULOCARDIAC REFLEX ON THE HEART RATE IN NON-ATROPINIZED PATIENTS DURING CATARACT SURGERY UNDER LOCAL ANAESTHESIA

Salam N Asfar; Jasim M Salman; Salsabel Shakir Mahmood

Basrah Journal of Surgery, Volume 20, Issue 2, Pages 41-45
DOI: 10.33762/bsurg.2014.98890

Oculocardiac reflex (OCR) is an event seen during the cataract operation revealed as bradycardia. The situation is triggered by pulling or stitching of external ocular muscles. Anesthesiologists used atropine for controlling this reflex if ensues.
This study aimed to estimate the incidence of the oculocardiac reflex during cataract surgery under local anesthesia (LA) and to assess the need for atropine to avoid this event.
This study included eighty patients aged 45-80 years with class I or II ASA physical status listed for elective cataract extraction and intraocular lens (IOL) implantation under peribulbar block. The past medical history, drugs history, investigations and baseline vital signs were all observed and recorded. The observer continuously monitors heart rate readings. Oxygen was given to all patients through nasal cannula while spontaneously breathing.
The results showed a significant drop in the heart rate following superior rectus muscle grasp and stitching (5.69%). This finding was observed following sedation (6.19%) and after removing of the stitch (6.22%), which indicates triggering of OCR. This slowing in heart rate did not require the use of atropine as bradycardia did not reach a serious level.
In conclusion, the alterations in heart rate during cataract surgery observed mainly at handling of the extra-ocular muscles and following sedation. Atropine is not essential as a routine premedication in cataract surgery, particularly in geriatric populations in order to avoid the major side effects of atropine such as: tachyarrhythmias, central nervous system toxicity and urine retention, however, it should be accessible for administration if bradycardia ensues.

THE FINDINGS OF SPUTUM CULTURE OF INTUBATED MECHANICALLY VENTILATED PATIENTS VERSUS NON-INTUBATED PATIENTS IN THE ICU

Nawfal Ali Mubark

Basrah Journal of Surgery, Volume 18, Issue 2, Pages 41-46
DOI: 10.33762/bsurg.2012.64613

A prospective clinical study was carried out in the ICU at Al-Basrah & AI-Tahreer General Hospitals to determine the percentage of positive sputum culture among intubated & mechanically ventilated patients compared to non-intubated patients, reflecting the impact of intubation and mechanical ventilation on increased risk of nosocomial infection and subsequent increased frequency of morbidity and mortality in ICU patients.
One hundred & twenty patients were admitted to these ICUs during a 6-months period (November 2008 to April 2009), they were 55 Females and 65 Males with mean age of 44.14 year (range 4-86year). Among 60 intubated ventilated patients, 25 (41.7%) had positive sputum culture. The bacteriology of positive sputum culture was caused predominantly by Pseudomonas aeruginosa in 36% followed by Klebsiella species in 28%, streptococcus pneumonia 24% and Escherichia coli in 12%. Among 60 non intubated patients, 8 (13.3%) had positive sputum culture. The bacteriology of positive sputum culture was caused predominantly by Streptococcus pneumonia in 50% followed by Pseudomonas aeruginosa in 25% and Klebsiella species in 25%.
This study confirmed that intubation and mechanical ventilation (mechanical interference) are risk factors that lead to increase the rate of nosocomial infection and subsequent increased frequency of morbidity and mortality in ICU patients.

NON-OBSTETRIC /GYNAECOLOGIC ABDOMINAL SURGERY DURING PREGNANCY

Majeed H AlwanF

Basrah Journal of Surgery, Volume 11, Issue 1, Pages 20-31
DOI: 10.33762/bsurg.2005.55415

Pregnancy is the only physiologic condition that is treated in the hospital environment. All other medical conditions that are treated in such a setting are pathologic. When a pregnant patient develops a pathologic condition that requires surgical intervention, it is imperative to remember that the lives of two individuals are involved, the mother and the foetus. In such settings it is essential that the treating surgeon understand the physiologic states of these two individuals as an interdependent symbiotic relationship. Not only must appropriate maternal care be rendered, prevention of foetal complications is also desirable.
Changing physiology and anatomical landmarks frequently cause confusion and delay in dealing with surgical problems in the pregnant patient. Both symptoms and signs could be modified, contributing to delay in seeking medical attention, timely referral for surgical evaluation, or the initiation of appropriate diagnostic procedures.
Surgery during pregnancy is an uncommon event, but one that creates a great deal of anxiety for both patients and medical practitioners. Delays in diagnosis and definitive treatment represent the most significant risk for untoward outcome in both the mother and the foetus.
Laparoscopic surgery has rapidly and widely spread in the management of wide abdominal conditions, which resulted in several significant benefits to the non-gravid patients. Pregnant patients and their foetuses could drive the same benefits from minimally invasive surgery, which are received by the non-gravidas. However, due to the several physiological and anatomical factors encountered during pregnancy many issues need to be thought about and dealt with.
Optimal surgical treatment of the pregnant patient will be realized when there is collaboration between the various subspecialties involved in her care.