Editorial
GIT Surgery
Samir Johna
Abstract
There is a wide range for the cost of ligating the base of the appendix. In this editorial we provide the several available options and suggest using a cost effective method as part of financial stewardship to contain the cost ofsurgeical care.
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There is a wide range for the cost of ligating the base of the appendix. In this editorial we provide the several available options and suggest using a cost effective method as part of financial stewardship to contain the cost ofsurgeical care.
Editorial
GIT Surgery
Samir Johna
Abstract
The function of the appendix and the role it plays in the human body remain a mystery. Recent data have shown a contradicting evidence. On the one hand, removing the appendix lowers the risk for contracting ulcerative colitis, while on the other, it increases the risk for contracting Crohn's disease. ...
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The function of the appendix and the role it plays in the human body remain a mystery. Recent data have shown a contradicting evidence. On the one hand, removing the appendix lowers the risk for contracting ulcerative colitis, while on the other, it increases the risk for contracting Crohn's disease. We wonder if this would have any bearing on the way we manage acute appendicitis.
Research Paper
Anaesthesia and Intensive Care
Vasudha Govil; Richa Malik; Prashant Kummar; Anju Rani; Sudha Puhal
Abstract
BackgroundNeurosurgery is associated with high incidence of PONV. 5HT3 Antagonists are highly specific for the treatment of nausea and vomiting. They are preferred antiemetic agents in neurosurgeries due to the lack of sedation and extrapyramidal reactions. The aim of the study is to compare the effect ...
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BackgroundNeurosurgery is associated with high incidence of PONV. 5HT3 Antagonists are highly specific for the treatment of nausea and vomiting. They are preferred antiemetic agents in neurosurgeries due to the lack of sedation and extrapyramidal reactions. The aim of the study is to compare the effect of ondansetron, granisetron and palonosetron on postoperative nausea and vomiting in patients undergoing craniotomy under general anaesthesia.Material and methodsA total of 75 adult patients, of either sex, age group of 18-60 years, belonging to ASA I, II and III, scheduled to undergo elective neurosurgical procedure, under general anaesthesia, were enrolled in the prospective, randomized, double blind study. Anaesthesia was induced with fentanyl 2 µgkg-1 and propofol 2 mgkg-1 and vecuroniun bromide 0.1 mgkg-1 was given to facilitate endotracheal intubation. At the time of dura closure, patients were randomly allocated to one of the three groups (n=25 each) Group O: to receive injection ondansetron 4 mg i/v, Group G: to receive injection granisetron 1 mg i/v and Group P: to receive injection palonosetron 0.075 mg i/v. Observer recorded episode of nausea and vomiting, use of rescue antiemetics, degree of satisfaction and variation in ECG post operatively.ResultsThe cumulative incidence of PONV in 0 to 48 hrs postoperatively was 57.33%. The incidence of PONV amongst the three groups is statistically significant with the least incidence in Group P (p
Original Article
Surgery
vinamra mittal; rajat yadav; T. K. RAjesh
Abstract
Gallbladder cancer (GBC) is an aggressive malignancy with an extremely poor prognosis. It is the most common cancer of the biliary tree. The early symptoms of gallbladder carcinoma are generally nonspecific and often mimic those of more common calculous biliary diseases. As a result, most cases are diagnosed ...
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Gallbladder cancer (GBC) is an aggressive malignancy with an extremely poor prognosis. It is the most common cancer of the biliary tree. The early symptoms of gallbladder carcinoma are generally nonspecific and often mimic those of more common calculous biliary diseases. As a result, most cases are diagnosed at an advanced stage, leading to a dismal prognosis, with a five-year survival rate of less than 5%.Materials & MethodsThis prospective observational study focuses on the epidemiology and clinical profile of patients diagnosed with gallbladder carcinoma who presented to the Department of Surgery at BPKIHS, Dharan, over a one-year period from September 2017 to September 2018. A total of 30 patients with either diagnosed or incidental gallbladder carcinoma were included in the study.ResultsMost patients (n=26, 86.6%) presented within six months of symptom onset. The median duration of illness was 2±5.89 months, ranging from 0.5 to 24 months. Transabdominal ultrasonography detected the disease in 26 (86.6%) of the 30 cases, with the most commonly affected sites being the fundus and body (76.9%).Among 14 cases deemed resectable based on CT imaging, intraoperative findings revealed that seven (50%) were unresectable—three due to metastasis and four due to locally advanced disease with hilar infiltration. Ultimately, seven patients underwent radical resection with curative intent.ConclusionThis study highlights that gallbladder carcinoma predominantly affects middle-aged individuals, with a higher prevalence among females. The majority of cases are diagnosed at an advanced, often unresectable stage, underscoring the poor prognosis associated with the disease.
Original Article
Urosurgery
Chengalvarayan G; Thanveer Ahamed Z; Sivasankar G
Abstract
Introduction: Bladder trabeculation is a morphological marker of detrusor hypertrophy, hypothesized to correlate with bladder outlet obstruction (BOO). This study investigates the prevalence, severity, and clinical implications of BOO in patients with and without LUTS.Methods: A prospective observational ...
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Introduction: Bladder trabeculation is a morphological marker of detrusor hypertrophy, hypothesized to correlate with bladder outlet obstruction (BOO). This study investigates the prevalence, severity, and clinical implications of BOO in patients with and without LUTS.Methods: A prospective observational study included 96 patients divided into Group 1 (Patient presenting for treatment of BOO symptoms) (BOO, n = 44) and Group 2 (Patient presenting for treatment of some other urological conditions) (non-BOO, n = 52). Trabeculation was graded via urethro-cystoscopy (Grade 0–3). Follow-up revealed previously unreported BOO symptoms in Group 2 patients with trabeculation.Results: Trabeculation prevalence was significantly higher in Group 1 (70.5% vs. 25.0%, p < 0.001). BOO patients exhibited 7.2-fold higher odds of trabeculation (95% CI: 2.98–17.32). On follow-up, all patients who were initially in Group 2 (non-BOO) with trabeculation (13/13) reported BOO/LUTS symptoms, suggesting underdiagnosis. Severe trabeculation (Grade 3) remained exclusive to Group 1.Conclusion: By this study, we re-confirm that bladder trabeculation strongly associates with Bladder outlet obstruction. Incidental trabeculation in asymptomatic patients may indicate an undiagnosed Bladder Outlet Obstruction, warranting thorough clinical evaluation.
Review Paper
Urosurgery
Samir BOURAS
Abstract
Introduction: The diagnosis and management of cT3a renal cell carcinoma with perirenal fat invasion (cT3a-PFI) remain complex due to the lack of standardized imaging protocols and the ambiguity in surgical decision-making. The aim of this review is to analyze this management approach primarily through ...
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Introduction: The diagnosis and management of cT3a renal cell carcinoma with perirenal fat invasion (cT3a-PFI) remain complex due to the lack of standardized imaging protocols and the ambiguity in surgical decision-making. The aim of this review is to analyze this management approach primarily through European and French guidelines.Methods: A literature search was conducted using PubMed, with keywords including "Renal cell carcinoma," "cT3a," "pT3a," and "perirenal fat invasion." Studies published in English between 2000 and 2024 were included. After screening, 42 articles were selected based on relevance, study design, and level of evidence.Results: Studies report better recurrence-free survival (RFS) and cancer-specific survival (CSS) for cT3a-PFI compared to sinus or vascular invasion. However, preoperative diagnosis remains challenging, with imaging features such as tumor contour irregularity showing low specificity for tumors >4 cm. Partial nephrectomy (PN) offers comparable oncological outcomes to radical nephrectomy (RN) for tumors ≤7 cm, while RN is preferred for larger tumors due to technical complexity and risk of positive margins. The favorable prognosis of cT3a-PFI ≤4 cm suggests these tumors may warrant reclassification within the TNM staging system.Discussion: The retrospective nature of most studies introduces selection bias, limiting the robustness of findings. Despite advancements, the lack of standardized diagnostic criteria remains a major barrier. Future research should refine surgical guidelines and explore advanced techniques such as radiomics and artificial intelligence.Conclusion: An individualized surgical approach tailored to tumor size and technical feasibility remains key to optimizing outcomes in cT3a-PFI RCC. Prospective studies are needed to address limitations and improve management.
Original Article
Cardiothoracic
Ola Murtadaa Albattat; Raheem Sharhan Balasim; Ammar Saleh Abbood; Warkaa Shamkhani
Abstract
Background: Acute Coronary Syndrome (ACS), encompassing STEMI, NSTEMI, and unstable angina, requires prompt and precise management strategies such as coronary angiography (CA) and percutaneous coronary intervention (PCI). While the global efficacy of these approaches is well-documented, limited data ...
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Background: Acute Coronary Syndrome (ACS), encompassing STEMI, NSTEMI, and unstable angina, requires prompt and precise management strategies such as coronary angiography (CA) and percutaneous coronary intervention (PCI). While the global efficacy of these approaches is well-documented, limited data exists regarding ACS patients epidemiological profile, presentation and management in Iraq. Understanding regional variations is vital for enhancing ACS care and improving clinical decision-making in the Iraqi healthcare system.Objectives: This study investigates sociodemographic characteristics, baseline patient and procedural features of ACS patients treated with PCI.Patients and Methods: A retrospective cross-sectional study was conducted at Basrah Specialist Cardiac Center between January and June 2024. Data from 388 ACS patients aged ≥18 years were analyzed, focusing on demographics, comorbidities, and clinical presentations. Variables included age, sex, BMI, smoking history, medical history and left ventricular function.Results: The study population were mostly middle-aged to elderly individuals (57.47% aged 50-69 years; mean age 59.11 years), predominantly male (70.6%). Urban and rural residents were nearly equal (50.8% vs. 49.2%). High comorbidity rates were noted: diabetes (53.5%), dyslipidemia (49.0%), and untreated hypertension (10.8%). STEMI was the most common diagnosis (64.95%), and PCI was the primary management (54.4%). Conclusions: This study highlights the high burden of cardiovascular risk factors among ACS patients undergoing PCI in Basrah, Iraq, emphasizing the need for better prevention. Despite advances, complications like pulmonary edema and cardiogenic shock remain not uncommon, underscoring the importance of early detection and prompt intervention.
Review Paper
Ophthalmology
Maytham Hashim Neamah; Zainab Taher
Abstract
Background: Introduction of anti-VEGF therapy has changed the way of management to the retinal diseases. Pegaptanib (Macugen)was the first to be approved and was followed by other agents, including ranibizumab (Lucentis, Genentech, San Francisco, Calif.), bevacizumab (Avastin, Genentech) and aflibercept ...
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Background: Introduction of anti-VEGF therapy has changed the way of management to the retinal diseases. Pegaptanib (Macugen)was the first to be approved and was followed by other agents, including ranibizumab (Lucentis, Genentech, San Francisco, Calif.), bevacizumab (Avastin, Genentech) and aflibercept (Eylea, Regeneron, Tarrytown, N.Y.).Studies have shown the safety and efficacy of these agents in the treatment of wet Age Related Macular Degeneration(ARMD), Retinal Vein Occlusion (RVO)and Diabetic Macular Oedema(DME). These drugs delivered into the vitreous cavity through pars plana injection, and are generally safe with little serious complications.Aim: To evaluate the rate of microbial contamination and safety aspects of multi puncture vials of bevacizumab (Avastin) and to determine the rate of endophthalmitis .Patients and Methods: A multi-centric prospective study conducted at the Basrah general teaching hospital and Al-Zubair general hospital, Basrah, Iraq, a total of 28 consecutive vials of bevacizumab {Avastin; F. Hoffmann-LaRoche Ltd. Switzerland} were used. A total 1096 injections were administered to 899 patients between September 2019 and November 2024. After puncture the vial, multidose used for intravitreal injections, residue bevacizumab in the vial was stored in the refrigerator at 2-8 ̊C and reused for up to 4 weeks. From each vial, a dose of 0.05 ml was withdrawn to a sterile 1ml syringe under aseptic technique and sent for bacterial gram staining and culture.Results: No evidence of microbial contamination was detected in 28 vials as approved by the results of microbial staining and culture. One patient of 899 patients who received intravitreal injections from these vials showed signs of inflammation, otherwise; no evidence of endophthalmits.Conclusions: This study propose that the content of multipuncture bevacizumab (Avastin) vials remain sterile over a period of 4 weeks without any microbial contamination if perfect aseptic and storage precautions are maintained. Using multidose of bevacizumab vials for intravitreal injection which stored for up to 4 weeks in refrigerator at temperature of 2-8 ̊C is safe.Keywords: Bevacizumab, Endophthalmitis, Microbial contamination, multi-use vials
Original Article
Anaesthesia and Intensive Care
Sura Abdul Hussien; Mazin Adnan Abbas; Bushra Abdulameer Lazim; Sura Saeed Abood
Abstract
Background: Tracheal intubation remains a cornerstone of airway management. Nasotracheal intubation (NTI) offers specific advantages, including reduced need for neck extension, making it particularly useful in patients with cervical spine instability or limited mouth opening. To guide the endotracheal ...
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Background: Tracheal intubation remains a cornerstone of airway management. Nasotracheal intubation (NTI) offers specific advantages, including reduced need for neck extension, making it particularly useful in patients with cervical spine instability or limited mouth opening. To guide the endotracheal tube (ETT) into the trachea, Magill forceps or gradual cuff inflation may be used. While Magill forceps are effective, they carry risks of mucosal trauma and cuff damage and require adequate mouth opening.Objective: To compare the performance of video-assisted NTI using Magill forceps versus the cuff inflation technique in terms of intubation time, number of attempts, and complicationsMethods: This prospective, randomized study was conducted in the intensive care unit of a tertiary hospital. Fifty adult patients requiring NTI were allocated into two equal groups (n=25): one undergoing intubation with Magill forceps, the other using the cuff inflation technique. All procedures were performed under VL guidance.Results: Smooth intubation was achieved in 64% of the Magill group and 48% of the cuff inflation group. Absolute failure occurred in one Magill case and two inflation cases. Bleeding occurred equally in both groups (12%). A second intubation attempt was required in 24% of the Magill group and 32% of the cuff inflation group. Cuff damage occurred in three cases in the Magill group but was not observed in the inflation group. No statistically significant differences were found between groups in primary outcomes (p > 0.05). One patient experienced transient hypoxemia (SpO₂ <92%) and was managed with oral intubation. No serious complications were recorded.Conclusion: Both techniques are feasible and safe when combined. The cuff inflation method offers advantages in patients with limited mouth opening and reduces the risk of ETT cuff damage. However, tip misdirection during inflation can occur and may require additional manipulation.
Research Paper
Medicine
mais razaq jaafar; Hassanin Kareem hasan; Mortada Abdulhussien Jubara
Abstract
Background: Pulsed radiofrequency is an interventional pain management technique that has been successful in treating radicular pain brought on by nerve damage, trigeminal neuralgia, and thoracic postherpetic neuralgia.Aim of the study: To examine both the therapeutic benefits and potential risks of ...
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Background: Pulsed radiofrequency is an interventional pain management technique that has been successful in treating radicular pain brought on by nerve damage, trigeminal neuralgia, and thoracic postherpetic neuralgia.Aim of the study: To examine both the therapeutic benefits and potential risks of pulse radiofrequency in the management of pain and paresthesia in patients with diabetes mellitus.Patients and method: A clinical therapeutic trial study was done in Baghdad, Iraq between April 1 and October 1, 2024. A convenient sample of 80 patients who had diabetic neuropathy were enrolled. The intervention included pulse radiofrequency for two sessions at three months intervals.Results: The proportion of patients with severe paresthesia significantly decreased after the first session (P-value=0.006). Then, it significantly decreased after the second session compared to the first session (P-value=0.029). There was an improvement in the pain as estimated by the VAS score after the first session and after the second session compared to the first session (P-value= were 0.003 and 0.004, respectively).Conclusion: About 50–70% of the patients had pain reduction with improved mobility and reduced medication dependence. It is recommended to repeat pulsed radiofrequency if pain returns (every 3–6 months if needed).
Original Article
Anaesthesia and Intensive Care
Vasudha Govil; Anupma Jinagal; Anju Rani; Sudha Puhal; Vinay Phogat; Sahil Arora
Abstract
IntroductionThe neurotoxic snakes, cobra and krait, are most commonly found in the northern India. The incidence of snake bites increases drastically in the rainy months of July to September. Respiratory paralysis is the most common cause of mortality in snake bite venomation. It can be preventable by ...
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IntroductionThe neurotoxic snakes, cobra and krait, are most commonly found in the northern India. The incidence of snake bites increases drastically in the rainy months of July to September. Respiratory paralysis is the most common cause of mortality in snake bite venomation. It can be preventable by timely arrival at the hospital and timely administration of anti snake venom.Material and methodsAll the snake bite victims, 18 years and above, who presented in the medicine emergency with neurological signs and symptoms in the time period June 2023- may 2024 were screened by the researcher and data of those patients who were subsequently shifted in the ICU after management in the medicine emergency was recorded and further analysed for demographic, snake bite characteristics, hospital stay and ASV administration.ResultsThirty patients (21.4%) met the inclusion criteria with the complete records and were included for the final study. 86.66% patients presented in the early morning hours between 12 am to 6 am Eighteen patients were male and twelve patients were female, with 56% patients in the age group ranging from 25-50 years. 80% of the patients presented in the monsoon months of July and August. Association between time taken to reach hospital and duration of mechanical ventilation and time to complete resolution of symptoms was noted and it was found to be highly significant (p<0.05)
