Print ISSN: 1683-3589

Online ISSN: 2409-501X

Main Subjects : surgery


PROFILE OF MICROORGANISM AND ANTIBIOTIC SENSITIVITY PATTERN IN PATIENTS UNDERGOING EMERGENCY LAPAROTOMY FOR PERITONITIS

VISHNU JAYAPRAKASH; POORVI SHARMA; RAJGOPAL SHENOY; SUNIL KRISHNA M

Basrah Journal of Surgery, 2022, Volume 28, Issue 1, Pages 46-60
DOI: 10.33762/bsurg.2022.132161.1015

BACKGROUND: Peritonitis is one of the common emergencies and multiple organisms have been implicated in the pathogenesis. Inappropriate and prolonged use of antibiotics have been attributed to the emergence of antibiotic resistance. METHODS: Retrospective observational study, from 1st January 2018 to 31st December 2019(Two years). Patients with secondary peritonitis undergoing surgery are included in this study. Common pathogens and its antibiotic sensitivity pattern from peritoneal fluid, blood and surgical site were studied. RESULTS: Perforation peritonitis is the most common cause of peritonitis. Cefaperazone-sulbactum and Piperacillin-tazobactum were the common empirical antibiotics prescribed. Escherichia coli followed by Klebsiella pneumonia were the commonest microorganism isolated from the peritoneal fluid and found to have adequate sensitivity for the empirical antibiotics. Enterococus and candida were the common organism isolated in blood culture. E-coli and Klebsiella from wound swab showed higher resistance to the empirical antibiotics. Large intestine perforation has higher percentage of surgical site infection. CONCLUSION: E-coli and Klebsiella pneumoniae were the common cause of secondary peritonitis. The empirical antibiotic is shown to be sensitive to the common organism isolated from peritoneal cavity. Wound swab isolates have shown higher resistance to antibiotics hence isolating the organism and assessing the sensitivity might be prudent. Due to geographical variation of antibiotic resistance trends to microorganism, it is prudent to have antibiotic surveillance on a local basis that can recommend appropriate antibiotics.

A comparison between rural and urban residents attending Basrah Dental College south of Iraq for tooth extraction between 2018-2021 and its relation to the dental health care situation in Iraq

Sundus Abdul Wadood Aljazaeri

Basrah Journal of Surgery, 2022, Volume 28, Issue 1, Pages 2-13
DOI: 10.33762/bsurg.2022.133215.1021

Abstract
Most studies confirmed caries are the main cause of tooth extraction in urban and rural areas, especially in young people. There is a relationship between the level of education and dental extraction, particularly in rural areas. In this cross-sectional examination overall 1257 patients were treated in the teaching clinic of the oral and maxillofacial surgery department, College of Dentistry, the University of Basrah between 2018-2021. Data were collected from patients' data after taking the agreement of the ethical committee in the college. The comparisons include age, gender, educational level, occupation, chief complaint, diagnosis and tooth site. reasons and pattern of tooth loss were recorded and data were computed on SPSS. Version 20. The numbers of tooth extraction in urban and rural were very close 632(50.3%) and 624(49.7%) extractions respectively. The male to female percentage was 38.2 %, 61.8% respectively and the highest number of extractions was observed in females in rural areas most of the patients are a housewife. Tooth extraction has seen more in the third, fourth and fifth decade than other age groups 20.4%, 22%, 19.9% respectively. A significant difference between education and dental extraction was noted between urban and rural areas. The main complaint was for prosthetic therapy 45.3% and 43.2% because of pain. The largest proportion considered as the main cause of extraction was dental caries consequences of 80.5% and the lowest 16.9% from periodontal disease.
Key Words: Extraction, Rural, Urban, dental health care, First Molar.

the benefit of tympanometry for certain ear diseases

Hussam Haider Salman; Adnan khudier yaqoop; Rafid Y. Jabbar Almaidi

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 60-64
DOI: 10.33762/bsurg.2021.130727.1007


 Tympanometry is an objective test measure the mobility (compliance) of the tympanic membrane as a function of applied air pressure in external canal, It is particularly useful in assessing the secretory otitis media during childhood. This is a prospective study performed at ENT department of the Basrah Teaching Hospital for the period from November / 2013 to February / 2014. The study is to assess the advantage of tympanometry as a diagnostic tool and to audit the uses of tympanometry in the ear diseases in ENT department of Basrah Teaching Hospital. The statistical calculations were carried out using chi-square test. The p value >0.05 was considered statistically insignificant. Fifty patients aged (4—84years) who were referred by otolaryngologist to our audiological unit for audiological assessment were included in the study. Out of these 50 patients (55 ears had otitis media with effusion, 12 ears had Eustachian tube dysfunction, 4 ears had barotraumas, 7 ears had acute otitis media, 4 ears had chronic suppurative otitis media, 2 ears had otosclerosis and 15 ears were normal on clinical examination). The clinical diagnoses was compared with tympanometric findings and the coincidence between two, was as follow; 80% in otitis media with effusion, 75% in barotraumas , 100% in acute otitis media. In conclusion; tympanometry is an important tool in the diagnosis of some of the ear diseases. It is not necessary to performed in every case as the clinical examination could clarify the diagnosis in most cases . Keywords: benefit , tympanometry

Quality of Life in Women with Breast Cancer attending Basrah Oncology Centre

Elaf Muhammad Saleh AL-Tawri; Narjes A.H Ajeel

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 43-49
DOI: 10.33762/bsurg.2021.130806.1009

Abstract
Background
Quality of life issues are increasingly being recognized as critical in the spectrum of cancer treatment that the prolongation of survival cannot be the only therapeutic objective. In some cases, patients and physicians may have to choose between the prospects of longer survival or better quality of life during the remaining time.
Patients and methods: This is a cross sectional study carried out to measure health-related quality of life in 275 women with breast cancer attending Al-Basrah oncology center during six months period, data were collected through direct interview using the standard European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-C30) and its complementary questionnaire specific for breast cancer (QLQ -BR -23).
Results: The study showed that the mean score for global QoLwas52.39 ±17.1 indicating that the patients had average scale score. The most important predictors of global QoL were physical, role, cognitive and sexual functions in addition to future perspective and arm symptoms.
Conclusion
The most important determinants predicting global QOL were role, physical, cognitive and sexual functions in addition to future perspective and arm symptoms.

THE OUTCOME OF DOUBLE DARTOS VERSUS SINGLE LAYER FLAP IN SNODGRASS URETHROPLASTY FOR DISTAL HYPOSPADIAS REPAIR IN BASRA TRAINING CENTER OF UROLOGY

Murtadha Almusafer; Safaa Gatea Mezban; Murtada Faisal

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 2-8
DOI: 10.33762/bsurg.2021.170236

Hypospadias, a nomination of medical term which was derived from the Greek terms: hypo (under) and spadon (rent, fissure). It is one of the congenital abnormalities of the genitourinary tract. There are about 400 different procedures described for correction of this type of anomaly, but Tubularized Incised Plate (TIP) Urethroplasty is considered the most popular one, and there are multiple variations in this procedure to get high success rate and decrease the complications. In this study, we compare between single layer dartos flap versus double layer dorsal flaps in TIP urethroplasty. This is to assess the outcomes of double dartos flaps versus single layer flap in TIP urethroplasty for primary distal hypospadias repair in Basrah Teaching Center regarding the success rate, and to investigate the importance of double flaps in preventing possible complications in particular, urethral fistula. A cross sectional prospective study was done in Basra Teaching Hospital, between January 2018 to March 2020. A total of 50 boys, 2 to 10 year- old with coronal and sub coronal primary Hypospadias were treated with TIP urethroplasty (Snodgrass procedure) by one surgical team, who were referred to Basrah Teaching Hospital from private and outpatient clinics. Patients were divided into 2 groups: (group I: 25 patients) single layer Dartos flap & (group II: 25 patients) double layers of Dartos flaps. Six patients were missing during follow up, coincidentally 3 patients in each group. The mean age was 4.55 and 4.86 year for groups I, II respectively, the mean operative time was 88.81 and 91.86 minutes for group I & group II respectively. The success rate was (81%) and (86%) for group I, II respectively, with exception of complications which need re-do surgery. Urethrocutaneous fistula (UF) was developed in (22.7%) in group I, and in (4.5%) in group II. Bleeding was happened in 2 cases (9.1%) in group I and 3 cases (13.6%) in group II. Meatal stenosis was diagnosed in (9.1%) in group I and (13.6%) in group II. Glans dehiscence was seen in 1 case (4.5%) for each group. There was a significant difference between the two groups in the occurrence of UF (P = 0.001). According to our evidence in this study, double dartos flaps is easy to be harvested, safe procedure, and represents very good choice for UF prevention. Although the number of complicated patients regarding bleeding and meatal stenosis are higher in group II than group I but they were statistically insignificant. Keywords: Hypospadias, Urethroplasty, Tubularized Incised Plate (TIP), urethral fistula, dartos flaps.

laser vs optical urethrotomy for urethral stricture

Ali Haseeb; Mahmood shakir abdulkarim karbalaie

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 9-19
DOI: 10.33762/bsurg.2021.131829.1013

A urethral stricture is a scar of the subepithelial tissue of the corpus spongiosum that
constricts the urethral lumen. As the constriction increases, obstruction occurs and
leads to symptoms which may be related to the obstruction or secondary to it(1).
(Figure 1).
The term stricture usually used for constrictions of the anterior urethra. Otherwise in
the posterior urethra the terms stenosis or contracture are applied(2).
The site and the age of the patient may give a hint about the cause of the stricture. For
example, Meatal strictures may be caused by lichen sclerosis (the most common
identifiable cause of anterior urethral stricture in young adults), and instrumentation or
poor hygiene at any age(2)
A urethral stricture is a scar of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen. As the constriction increases, obstruction occurs and leads to symptoms which may be related to the obstruction or secondary to it(1).
(Figure 1).

The term stricture usually used for constrictions of the anterior urethra. Otherwise in the posterior urethra the terms stenosis or contracture are applied(2).
The site and the age of the patient may give a hint about the cause of the stricture. For example, Meatal strictures may be caused by lichen sclerosis (the most common identifiable cause of anterior urethral stricture in young adults), and instrumentation or poor hygiene at any age(2).

A comparative study between traditional and ejaculation preserving Transurethral resection of prostate

Issam Al-Azzawi; Ihab Mahmood Hussein

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 20-25
DOI: 10.33762/bsurg.2021.131298.1011

This is to evaluate the efficacy & safety of a modified ejaculation preservation Transurethral Resection of Prostate ( epTURP ) , in comparison with the traditional technique - Transurethral Resection of Prostate ( TURP ) . A prospective controlled clinical interventional study whereby 40 Iraqi male patients scheduled for TURP were randomly assigned into 2 groups; group 1 treated with epTURP, and group 2 treated with TURP. Pre & post-operative evaluation of the patients included history taking, filling the international prostate symptom score ( IPSS ), the international index for erectile function ( IIEF – 15); questions 9,10,13 & 14, measurement of ejaculate volume, Uroflowmetry (Q-max) & measurement of Post Voiding Residual urine (PVR). Follow up schedule was at 6 weeks & 3 months post-operatively. The Mean age of patients was 59 year, mean prostate volume was 46 ml. Post-operatively 19/22 patients in the epTURP group & 3/18 patients in the TURP group had preserved their antegrade ejaculation, which led to a significant difference between the 2 groups in mean ejaculate volume & IIEF .There was a comparable improvement in post-operative values of IPSS, Q-max & PVR in both groups. Complications were minimal & manageable in both groups. In Conclusion The epTURP was in our experience a safe & effective technique in preserving antegrade ejaculation & improving urinary outflow in patients with prostate volume approaches 50 ml . Keywords: Transurethral resection of prostate, ejaculation preservation, uroflowmetry, post voiding residue, ejaculate volume

OUTCOME OF TRANSORAL ENDOSCOPIC THYROIDECTOMY VESTIBULAR APPROACH (TOETVA) IN COMPARISON WITH OPEN THYROIDECTOMY FOR BENIGN THYROID NODULES

Sadq Kadem; Sabah Abdulsahb Mohamd; Zainab Taher Ibrahim

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 17-24
DOI: 10.33762/bsurg.2021.168428

Open thyroidectomy; is the gold standard surgical procedure for thyroid diseases, but the incision scar in the anterior aspect of the neck due to this approach cannot be avoided and may results in a permanent cosmetic defect. Therefore, there is a need to improve postoperative quality of life, including cosmetics. Recently, transoral endoscopic thyroidectomy has been developed; it is a natural orifice thyroid surgery, minimally invasive and completely scar free. This study aimed to describe the outcome, patient’s satisfaction, and complications after hemithyroidectomy for benign thyroid nodules by transoral endoscopic vestibular approach in comparison with open approach. This study was conducted in Al-Shiffa General hospital, Basrah, Iraq from August 2017 to June 2019 and was approved by a local ethical committee.Fifty patients with benign thyroid nodules who are candidate for hemithyroidectomy were included in the study; they were divided into two groups according to the method for thyroidectomy which was either conventional open or transoral endoscopic thyroidectomy vestibular approach based on the patients’ preferences. All operations were performed by the same surgical team. The results of this study showed that 24 (48%) of them operated upon by transoral endoscopic thyroidectomy vestibular approach, while the remaining 26 (52%) patients have been operated upon by open thyroidectomy approach. Transoral endoscopic thyroidectomy vestibular approach reported significant longer operative time, has comparable rate of complications with an excellent cosmetic outcome and better postoperative patients’ satisfaction in comparison to open thyroidectomy.In conclusion, transoral endoscopic thyroidectomy vestibular approach is a safe and feasible procedure with an excellent cosmetic outcome and better patients’ satisfaction. At present, it is a relatively time-consuming procedure and, therefore, candidate patients with a strong motivation for scar free surgery are recommended.Key words: Thyroidectomy; Endoscopic thyroidectomy; Transoral thyroidectomy; Benign, Nodule

RISK FACTORS FOR THE DEVELOPMENT OF BRAIN METASTASES IN PATIENTS WITH METASTATIC BREAST CANCER

Hayder Hashim Abdulsamad; Mazin H Al-Hawwaz

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 30-35
DOI: 10.33762/bsurg.2021.168434

Metastatic breast cancer is the second most common cancer associated with brain metastases;it has become a major life-limiting problem in those patients with metastatic breast cancer.This study aimed to detect early brain metastasis and intent to manage so to decrease disability and mortality in patients with breast cancer.This is a retrospective study analysing patients with metastatic breast cancer during the period from February 2018 to August 2019 at Basrah Oncology Centre which is the main tertiary referral hospital serving the southern part of Iraq. During the study duration (around 18 months), we found that risk factors for developing brain metastasis are tumour size, nodal involvement, tumour grade, hormone receptor (if negative), human epidermal growth factor2 (If positive) and radiotherapy (if not given as adjuvant) .In conclusion, the tumour size, grade, nodal involvement, whether the hormone receptors positive or negative, and if the patient received radiotherapy or not, all are predictive factors tobe considered, so patients should have appropriate imaging technique.Key words: Brain metastasis, breast cancer, risk factors.

EFFECT OF PULSATILE FLOW ON RENAL FUNCTION IN ELDERLY PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY

Amanj Kamal Mohammed

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 54-59
DOI: 10.33762/bsurg.2019.164515

Abstract
 The incidence of acute kidney injury (AKI) after on-pump coronary artery bypass graft (CABG) varies among studies but can be reduced if pulsatile flow is used.
 The aim of this study is to evaluate pulsatile flow impact on renal function of elderly patients undergoing CABG.
 Over one year (April 2014 to April 2015) 48 patients above the age of 65 underwent on-pump CABG in our institute. Patients were divided into two groups; pulsatile flow (PFG) and non-pulsatile flow (NPFG) groups. Serum creatinine (S.Cr), creatinine clearance (Cr.Cl) and per-perfusion urine output (UO) were measured. AKI Network criteria were adopted for diagnosis.
 Mean age was 68 in PFG and 69 in NPFG. Males constituted 83.3% of PFG and 79.2% of NPFG. Although 37.5% of PFG and 41.7% of NPFG were hypertensive, all patients had normal ejection fraction (EF). Both groups had nearly 3 coronary anastomoses, cardiopulmonary bypass (CPB) time of 90 min, cross clamp time of 71 min and mean perfusion pressure of 70 mmHg. Mean S.Cr was the same (0.8 mg/dl) in both groups on 1st postoperative day (POD) but UO was significantly larger (708 ml in PFG vs. 648 ml in NPFG). On 3rd POD, S. Cr didn’t change in PFG but it has significantly increased in NPFG (from 0.76 to 1.0 mg/dl). Moreover, Cr.Cl has significantly improved in PFG (81 vs. 72 ml/min in NPFG). Seven of 48 patients (14.6 %) developed AKI (6; 25% in NPFG).
 In conclusion; Pulsatile perfusion technique is a simple and safe measure to minimize AKI in the elderly.
 
Keywords: Coronary artery bypass graft, elderly, cardiopulmonary bypass, pulsatile flow, non-pulsatile flow, acute kidney injury, serum creatinine, creatinine clearance

THE ROLE OF N-ACETYLCYSTEINE IN THE TREATMENT OF OTITIS MEDIA WITH EFFUSION

Dhiaa Abdullah Fadhel; Isam M Al-Shareda; Haider MS Al-Attar; Ahmed A Alansary

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 70-75
DOI: 10.33762/bsurg.2019.164517

Otitis media with effusion (OME) is a chronic accumulation of fluid within the middle ear cleft and sometimes the mastoid air cells system. The disease is more common among children. Surgical management is cost effective and carry complications from anaesthesia and surgical intervention. The condition can be resolved with high percentage by using mucopeptide breaking agent N-acetylcysteine
 The aim of this study is to evaluate the effect of N-acetylcysteine on the resolution of otitis media with effusion in children.
 Fifty seven children (107 ears) aged between 4-15 years with OME were included in this study. Patients underwent a thorough otorhinolaryngological examination and were divided into two groups; in the study group of 30 patients, N-acetylcysteine was administered, and the control group of 27 patients did not receive this treatment.
  Patient were followed-up at attendance, one month, two months and three months later with microscopical ear examination, tympanometric and pure tone audiometric examination.
 Patients were 39 males (68.4%) and 18 females(31.6%), 50 of them were with bilateral and 7 with unilateral disease. Following the treatment, there was improvement in the hearing loss as air bone gap was decreased. This improvement was statically significant in comparing the study and control groups (P value= 0.022). Number of ears with type A tympanogram increased to a rate of 74%, 71% in the right and left ears respectively in the study group. This rate was statically significant in comparing with the control group (P value=0.014).
 In conclusion, N-acetylcysteine is effective in the treatment of children with OME as well as that N-acetylcysteine has minimal side effect and can be used safely in patients who are medically unfit for general anaesthesia

MANAGEMENT OF CRISES DURING ANESTHESIA AND SURGERY. PART XVI: HARMS LINKED TO DRUGS ADMINISTERED DURING ANESTHESIA

Jasim M Salman; Salma Asfar

Basrah Journal of Surgery, 2019, Volume 25, Issue 1, Pages 74-75
DOI: 10.33762/bsurg.2019.163877

MANAGEMENT OF CRISES DURING ANESTHESIA AND SURGERY. PART XVI: HARMS LINKED TO DRUGS ADMINISTERED DURING ANESTHESIASalam N Asfar@ & Jasim M Salman# @MB,ChB, MSc, Professor of Anesthesiology, College of Medicine, University of Basrah. #MB,ChB, DA, FICMS, Assist. Prof. & Consultant Anesthesiologist, College of Medicine, University of Basrah, Basrah, IRAQ. Unpleasant drug incidents are common during medical action. In anesthetic practice, the probability of errors is greater because of more tension and rapidity. Morbidity and even mortality are more expected in the course of anesthesia. Apart from many hazards that patients are exposed to such as; Biological hazards, Mechanical hazards, Chemical hazards, Physical hazards, and Personal Hazards1, it seems that danger of drug problems are more.

EVALUTION OF BILATERAL V-Y ROTATION ADVANCEMENT FLAPS FOR TREATMENT OF FINGERTIP AMPUTATION

Jabir Raheem Hameed

Basrah Journal of Surgery, 2019, Volume 25, Issue 1, Pages 66-73
DOI: 10.33762/bsurg.2019.163876

EVALUTION OF BILATERAL V-Y ROTATION ADVANCEMENT FLAPS FOR TREATMENT OF FINGERTIP AMPUTATION Jabir Raheem Hameed* and Roaa Hamed Mahmood@*MB, ChB, FICMS, Consultant Plastic and Reconstructive Surgeon, Al-Sadr Teaching Hospital, Basrah. @MB, ChB, Candidate of CABHS, Plastic and Reconstructive Surgery, Al-Sadr Teaching Hospital, Basrah, IRAQ. Abstract Fingertip amputation is the most common injury of the upper limb. The goals of treating it are; covering the defect, achieve sensibility, preserving the length of the finger by using durable coverage, obtaining the satisfactory aesthetic appearance and allow the patient for faster return to work. This study aimed to evaluate the use of bilateral V-Y rotation advancement flaps for the management of fingertip amputations with exposed bones and to assess the functional and aesthetic outcome. Between January 2017 and August 2018, bilateral V-Y rotation advancement flaps was performed on eleven male patients, average age 32 years, whose fingertip amputation with variable planes and zones. Patients were followed-up for at least 6-12 months. Twenty two flaps were made on 11 fingers, there was no partial or total flap loss. Patients had neither cold intolerance nor scar hypersensitivity, no obvious hook nail deformity apart of one patient. Because flap have neurovascular bundle inside it, so no change in sensation or perfusion occur postoperatively. In conclusion, the V-Y rotation advancement flap is simple, single stage operation that is optimum for surgical reconstruction of any fingertip injury. It provides a good contour, finger pulp coverage and acceptable appearance. Keywords: Fingertip. Amputation, Pulpa, V-Y flap, Reconstruction.