Basrah Journal of Surgery

D
ecision making is very vital in all aspects of life, no matter how simple it is. The British use to say "it is always easy to be wise after the event".
The question arises; why not to be very wise before the events? is that impossible or difficult, I think no, it is very possible for those who carry wisdom, and difficult for those who are rush and ignorant.
In surgical practice, wisdom comes on the top of all priorities, so that complications will come to the minimum possible.
Sadly still on this earth there are many of surgeons who believe in doing surgery as soon as possible probably because of motives, which does not include the patient's benefits, on the other hand, it may include the surgeon's financial gain. So they believe in incision before decision. To them I believe, it is vital to have a prolonged history taking, to probe the patient's brain in order to get everything out of it.
Proper history taking is the key for success.

O
zone therapy is a term that describes a number of different practices in which oxygen, ozone, or hydrogen peroxide are administered via gas or water to kill disease microorganisms, improve cellular function, and promote the healing of damaged tissues. The rationale behind bio-oxidative therapies, as they are sometimes known, is the concept that as long as the body's needs for antioxidants are met, the use of certain oxidative substances will stimulate the movement of oxygen atoms from the bloodstream to the cells. With higher levels of oxygen in the tissues, bacteria and viruses are killed along with defective tissue cells. The healthy cells survive and multiply more rapidly. The result is a stronger immune system.
Ozone itself is a form of oxygen, O3, produced when ultraviolet light or an electric spark passes through air or oxygen. It is a toxic gas that creates free radicals, the opposite of what antioxidant vitamins do. Oxidation, however, is good when it occurs in harmful foreign organisms that have invaded the body. Ozone inactivates many disease bacteria and viruses.

Abstract
Medical health records form an essential part of a patient’s present and future health care, so proper recording and documentation is mandatory because improper record keeping can result in poor management as well as declining medical claims.
The aim of this study is to evaluate the degree of writing patient's medical records and the adherence of medical staff to document patients' information's in accurate and proper manner as a guide for management protocols.
This is a retrospective descriptive cross sectional study, carried out in Al-Basrah General Hospital from 1st of January to 15th of February 2015, 250 medical records randomly selected, admitted for both urgent and elective surgeries from the total number of records registered at 2015, The Information from the records are documented on scoring questionnaire arrange by the researchers.
The documentation varies from item to other, for information related to patient identity: name, address, occupation presented completely in 70%, 19.2%, and 60.9% respectively. Regarding medical history, the chief complaint was written in medical term in 39.2% while the duration of illness was documented in 57.2%, whereas present illness, review of system, past, social, family & drugs histories were completely presented in 17.6%, 1.6%, 19.6%, 3.6%, 2%, 20.8% respectively. 38.8 % for general examination, 66% for systemic examination, 32.4% for vital signs, 94.8 % for preoperative & operative anesthetic notes, and 46.8% for operative surgeon notes were not presented at all. The investigations & treatment present in 71.6% & 56.8% respectively while diagnosis was not mentioned in 87.4%. Regarding follow up, nursing notes, consent were not present in approximately 30% of data. The admission sheet was not present in 2.8% while discharging summary report was not present in 97.2%. For diet, height, weight, fluid chart were not recorded in 100%. A comparison between urgent & elective surgeries reveals that the recording was slightly better for elective but this is not statistically significant. The documentation of patient medical records in surgical department of Al-Basrah General Hospital is poor, the majority of sheets in the records lack most of Information that its presence is fundamental for patient management, and the majority of data are not documented in complete and proper manner.

Abstract
Historically, potentially infected surgical wounds, like in acute appendicitis, were recommended to be closed by interrupted skin suturing. However, this method of skin closure can leave a marked scar at the closure site after healing of the wound. On the other hand, there are no enough data about the potential risk increment in wound infection following skin closure by continuous subcuticular approach.
This is a prospective study aimed to compare the results of skin closure using interrupted mattress and subcuticular continuous approaches following appendectomy, in terms of postoperative wound infection rates.
One hundred and ten (110) patients with acute appendicitis admitted to Al-Sadir Teaching Hospital in the period between January 2013 and February 2014 were chosen for the study. The patients were divided into two groups. In one group, (58) patients, the appendectomy wound was closed by interrupted mattress, and patients in the other group, (52) patients, underwent continuous subcuticular skin closure. All patients were followed up for two days postoperatively in the hospital and seven days as outpatient follow-up for signs and symptoms of wound infection.
By assessing the effect of risk factors on the rate of post-appendectomy wound infection, the following results were obtained: Effect of gender on postoperative infection: Males: 8/59 (13.6%), Females 6/51 (11.8%), P value: 0.079. So the association between gender and rate of infection was not significant. Effect of smoking on postoperative infection: Smokers: 4/24 (16.7%), Non-smokers: 10/86 (11.6%), P value: 0.429. So the association between smoking and the rate of infection was not significant. Effect of family history of previous appendectomy on postoperative infection: Positive family history: 7/34 (20.6%), Negative family history: 7/76 (10.1%), P value: 2.738. So the association between family history and the rate of infection was not significant. Effect of history of previous abdominal operations on postoperative infection: Positive history: 1/7 (16.7%), Negative history: 13/103 (12.6%), P value: 0.066. Thus the association between history of previous abdominal operations and the rate of post-appendectomy wound infection was not significant.
In interrupted mattress skin closure group, 7/58 (12%) patients developed signs and symptoms of wound infection, whereas in the continuous subcuticular skin closure group, 7/52 (13.4%) patients developed wound infection.
In conclusion, there is no significant difference in the risk of wound infection between skin closure by interrupted mattress and continuous subcuticular approaches.

Abstract
Otitis media with effusion, which refers to the accumulation of fluid in the middle ear cavity without any signs of infection, is a common health problem both in pre-school and school age children. The etiology of otitis media with effusion is multifactorial and many risk factors may increase its incidence.
The aim of this study is to determine the frequency and risk factors of otitis media with effusion in school age children in Basrah.
In this descriptive prospective study; sixty patients aged between 6-12 years were included; they were 34 males and 26 females diagnosed as having otitis media with effusion in the period between July 2013 to April 2014; at Basrah General Hospital, Iraq. Pure tone audiometry, tympanometry, and lateral x-ray film of post nasal space were done for each patient after a full ENT history and examination . A questionnaire form was constructed to apply for each patient including the possible risk factors for developing otitis media with effusion such as age group, gender, parental smoking, allergy, history of acute infection, maternal education, family income, school type.
Otitis media with effusion was found to be higher (66.7%) in children aged between 6-8 years, males more than females with male to female ratio 1.3:1. (61.6%) were from rural area, parental smoking present in (65%), (58.3%) had history of allergy, (66.6%) with history of upper respiratory tract infection, low maternal educational level, low financial income (66.6%), attendance to public school, and the presence of adenoid hypertrophy (71%) were found to be associated with otitis media with effusion.
Conclusion and Recommendation: Environmental, epidemiologic and familial factors play an important role in etiology of otitis media with effusion. The parents must be informed about these modifiable risk factors, by this way the development or delayed diagnosis of the disease that may cause serious consequences can be prevented.

Abstract
Laparoscopic cholecystectomy has become the preferred choice of management for gallstone disease. In spite of various theories explored trying to assess different aspects of management and outcome to reach the acceptable safest technique in laparoscopic operation and to compare it with its counterpart. Many surgical methods were attempted to clarify their value in counteracting a serious complication of laparoscopic cholecystectomy, mainly is the bile duct injury.
This study aimed to evaluate the significance of critical view of safety as a technique of laparoscopic cholecystectomy concerning the issue of preventing bile duct injury in regard to the infundibular technique of dissection.
This is an observational study of two hundred fifty patients who were scheduled for laparoscopic cholecystectomy using critical view of safety technique compared with probably matched previously performed two hundred fifty of laparoscopic cholecystectomy using infundibular technique. The incidence of bile duct injury was analyzed in both groups.
The results shows that age, sex, body mass index and gall bladder status were comparable in both groups. The Incidence of bile duct injury in infundibular technique was (1.6%), while in critical view of safety technique the incidence was 0% which is statistically significant (P<0.05).
In conclusion, critical view of safety technique in laparoscopic cholecystectomy has a significant effect in preventing bile duct injury as compared to infundibular technique with comparable time of surgery and it is best to be the preferred technique in laparoscopic cholecystectomy.