Editorial
Orthopeadics
Raju Vaishya; Abhishek Vaish; Jasim M Salman
Abstract
Robotic and AI technologies are making waves in orthopaedic surgery by enhancing precision in procedures like total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgeries. While these advancements offer improved implant alignment and diagnostics, concerns linger regarding their high ...
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Robotic and AI technologies are making waves in orthopaedic surgery by enhancing precision in procedures like total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgeries. While these advancements offer improved implant alignment and diagnostics, concerns linger regarding their high costs, steep learning curves for surgeons, and limited long-term evidence surrounding their cost-effectiveness.
Original Article
Anaesthesia and Intensive Care
ANJU RANI; Amit Singh; Mamta Bhardwaj; Manisha Bhukar; Aishwarya Tamboli; Geetika Bhan
Abstract
Background and Aim: Deliberate hypotension to provide bloodless surgical field gives better visibility of the operative field, with reduced risk of injury to adjoining structures. This present study was conducted to compare three loading doses of dexmedetomidine for controlled hypotension in FESS surgery ...
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Background and Aim: Deliberate hypotension to provide bloodless surgical field gives better visibility of the operative field, with reduced risk of injury to adjoining structures. This present study was conducted to compare three loading doses of dexmedetomidine for controlled hypotension in FESS surgery under GA.Methods: Sixty patients aged between 18-60 years of either sex belonging to American Society of Anesthesiology I and II scheduled for FESS were randomly allocated to one of the three groups. Patients in group I, II and III received dexmedetomidine loading infusion at a rate of 1 μg kg-1, 0.8 μg kg-1 and 0.6 μg kg-1 respectively over 10 minutes followed by continuous infusion of 0.5 μg kg-1 h-1. The primary goal was to provide a MAP in a range of 60 - 70 mmHg before the start of surgery. Results:It was found that Mean HR as well as MAP was significantly lower in group I as compared to group II and III at multiple points. Also, time to achieve MAP was significantly lower in group I. (p < 0.001). surgical field visibility and surgeon satisfaction was better in group I.Conclusion: We concluded that using IV dexmedetomidine as an adjunct to other anesthetics is an acceptable approach to provide controlled hypotension. Administration of a loading dose of 1 µg kg-1 and 0.8 µg kg-1 compared to 0.6 µg kg-1, provides better surgical field conditions in terms of bleeding and visibility.
Original Article
Bariatric Surgery
Ahmed Mohammed; Issam Merdan; Falih Algazgooz
Abstract
ABSTRACT:Background:Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are a form of incretin-based therapy that treats hyperglycemia and, in some situations, cardiovascular risk in persons with type 2 diabetes. Aim:Is to determine the efficacy and safety of prescribing GLP1-RAs for patients who had ...
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ABSTRACT:Background:Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are a form of incretin-based therapy that treats hyperglycemia and, in some situations, cardiovascular risk in persons with type 2 diabetes. Aim:Is to determine the efficacy and safety of prescribing GLP1-RAs for patients who had suboptimal initial response or regained weight after bariatric surgery.PatientsandMethodes:A retrospective cross-sectional study was done from the 1st of February /2023 to the 1st of August/2024 in Al-Sadr Teaching Hospital, Iraq. Clinical data including (age, sex, height, weight, BMI, any chronic disease, time of bariatric surgery) were collected. Eighty-six patients were divided into two groups for the study. Seventy-two patients in the first group who gained weight after the weight nadir at least a year after bariatric surgery, 14 patients in the second group who had suboptimal initial response 12 months following bariatric surgery. Liraglutide was administered for 4 -8 months for both groups.Results:The study revealed that 70.9% of patients from both groups responded to the GLP1 therapy, with slightly higher responsiveness in the weight regain group (73.61%) than in the Suboptimal initial response group (57.14%), the difference was not statistically significant (p = 0.358).Both groups significantly reduced their BMI, with a mean pre-treatment to post-treatment BMI difference of 6.02 ±1.97 in the Suboptimal initial response group and 6.06 ± 1.21 in the weight regain group. However, there was no statistically significant difference between the two groups (p = 0.18).Both groups lost weight, with the Suboptimal initial response group losing 10.9% of their weight from pretreatment to post-treatment and the weight regain group gaining 11.3%. There was no statistically significant difference between the two groups (p = 0.112).Conclusion:We discovered that liraglutide 3.0 mg helped post-bariatric surgery patients who had either too much weight gain or insufficient weight loss.
Original Article
Urology
G Chengalvarayan; B Sivasankaran; G Sivasankar
Abstract
Background:Silodosin, a selective α1A-adrenoceptor blocker, improves Lower Urinary Tract Symptoms (LUTS) in Benign Prostatic Hyperplasia (BPH) by relaxing smooth muscle in the prostate and bladder neck. Its receptor specificity, however, predisposes patients to ejaculatory dysfunction, particularly ...
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Background:Silodosin, a selective α1A-adrenoceptor blocker, improves Lower Urinary Tract Symptoms (LUTS) in Benign Prostatic Hyperplasia (BPH) by relaxing smooth muscle in the prostate and bladder neck. Its receptor specificity, however, predisposes patients to ejaculatory dysfunction, particularly Anejaculation, which may affect compliance. This study aimed to determine the region-specific incidence and characterize the pattern of ejaculatory changes in Sexually active men receiving Silodosin 8 mg daily for BPH.Patients and Methods:A prospective, questionnaire-based descriptive study was conducted at the Institute of Urology, Madras Medical College–Rajiv Gandhi Government General Hospital, Chennai ,India, from December 2023 to May 2024. Sixty-six sexually active men with a clinical diagnosis of BPH, newly initiated on Silodosin 8 mg once daily, were enrolled. Data on demographic profile, perception of ejaculatory change, frequency, and type of dysfunction, compliance to treatment were obtained using a structured questionnaire.Results:Most participants were 55–60 years old (63.6%). Overall, 95.5% reported an ejaculatory change, of which 80.3% experienced it with every sexual act. Anejaculation was observed in 22.7% of patients, while 72.7% reported reduced ejaculate volume. Regarding treatment adherence, 65.1% continued therapy without interruption, 24.2% continued despite concerns, and only 6.0% discontinued due to ejaculatory dysfunction.Conclusion:Silodosin 8 mg is frequently associated with ejaculatory dysfunction, with anejaculation occurring in 22.7% of sexually active men. Despite these side effects, most patients continued therapy, highlighting the importance of counselling about potential sexual adverse events to support adherence and informed decision-making
Original Article
ENT
FIRAS BAQIR AL-HAMEED; AYMEN AHMED MOHSIN; AHMED FADHIL HASAN; FIRAS TAWFEEQ OBEID; RUKAIA NOORI ALMSHAYAKHCHI
Abstract
Bleeding into the surgical field is a major issue faced by endoscopic surgeons particularly if it is performed in narrow confines of the nasal cavity. Objective: To determine whether infiltration of a mixture of lidocaine: adrenaline into pterygopalatine fossa has an effect on intraoperative field bleeding ...
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Bleeding into the surgical field is a major issue faced by endoscopic surgeons particularly if it is performed in narrow confines of the nasal cavity. Objective: To determine whether infiltration of a mixture of lidocaine: adrenaline into pterygopalatine fossa has an effect on intraoperative field bleeding during endoscopic nasal surgery. Methods: A prospective, double blinded study was undertaken to assess 88 patients who had endoscopic nasal surgery indicated for chronic sinusitis with or without nasal polyps and dacryocystorhinostomy. Patients who received injection were selected randomly and the same anaesthetist infiltrated a solution of 2% lidocaine and 1:100,000 adrenaline into pterygopalatine fossa of all patients. All operations were undertaken by the same surgeon who assessed intraoperative bleeding every 15 minutes according to Boezaart and Van der Merwe grading system. Results: The difference in the degrees of bleeding among patients who received versus those who did not receive injection was not statistically significant (p-value = 0.36). Conclusion: According to the dose of treatment and condition applied in these operations, it seems that pterygopalatine fossa injection with lidocaine: adrenaline does not decrease intraoperative bleeding during endoscopic nasal surgery.
Research Paper
Cardiothoracic
Ahmed Ibraheem Abbas; Skalla Yusif Mawlood; Soma Sarwar Hamasalih; Sozyar Muhamad Abdulla
Abstract
AbstractBackground Thoracic trauma is a leading cause of morbidity and mortality, second only to head injuries in trauma-related deaths. Blunt injuries, particularly from road traffic accidents (RTAs), are more frequent than penetrating injuries, yet regional epidemiological data remain limited. Objective ...
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AbstractBackground Thoracic trauma is a leading cause of morbidity and mortality, second only to head injuries in trauma-related deaths. Blunt injuries, particularly from road traffic accidents (RTAs), are more frequent than penetrating injuries, yet regional epidemiological data remain limited. Objective To evaluate the prevalence, etiology, complications, and management of chest trauma among patients admitted to Shar Teaching Hospital (STH), Sulaimani, Kurdistan Region, Iraq. Methods This cross-sectional study included 152 consecutive chest trauma patients admitted between January and December 2024. Data on demographics, trauma type, etiology, complications, and management were collected using a structured questionnaire. Clinical evaluation included radiological and laboratory investigations, primary and secondary surveys, and emergency protocols. Data were analyzed using SPSS Version 26. Results Males predominated (male-to-female ratio 4.6:1), with a mean age of 34.9 years (range 4–87); young adults (19–30 years) represented 30.9% of cases. RTAs were the most common cause (45%), followed by stab injuries (24%) and falls from height (23%). Blunt trauma accounted for 71.1%, commonly resulting in rib fractures, lung contusions, pneumothorax, and hemothorax. Penetrating trauma comprised 28.9%, most often complicated by hemothorax or hemopneumothorax. Management was conservative in 51.3%, chest tube insertion in 42.8%, and surgical intervention in 5.9% of cases. Conclusion Chest trauma at STH predominantly affects young adult males, with RTAs as the leading cause. Blunt trauma is more frequent, and most patients respond well to non-operative management or tube thoracostomy. Surgical intervention is reserved for severe cases. These findings emphasize the importance of rapid diagnosis, timely intervention, and preventive strategies to reduce trauma-related morbidity and mortality.
Original Article
Surgery
Durgesh Goyal; Shelly Goyal; Anand Rai bansal; Tapan SAhu
Abstract
AbstractBackground: Incisional hernias frequently develop after abdominal surgeries, especially in patients with stomas, due to increased intra-abdominal pressure and impaired wound healing.Objective: To assess the safety and efficacy of simultaneous incisional hernia repair during stoma reversal.Methods: ...
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AbstractBackground: Incisional hernias frequently develop after abdominal surgeries, especially in patients with stomas, due to increased intra-abdominal pressure and impaired wound healing.Objective: To assess the safety and efficacy of simultaneous incisional hernia repair during stoma reversal.Methods: Twenty patients undergoing stoma reversal with concurrent primary repair of midline incisional hernias were included. Selection criteria involved the absence of active infection and medical suitability for a one-stage procedure. Postoperative outcomes, including complications and wound healing, were monitored.Results: No anastomotic leaks occurred. Twelve patients recovered uneventfully and were discharged by postoperative day 7. Minor wound discharge was observed in four patients, and localized collections appeared in three, all managed conservatively without fascial dehiscence. One patient developed a small fascial dehiscence, resolved with non-surgical management.Conclusion: Simultaneous stoma reversal and incisional hernia repair is a safe and effective option in appropriately selected patients, with low complication rates and favorable recovery.
Original Article
Anaesthesia and Intensive Care
Ritu Baloda; Susheela Taxak; Upasna Seth; Virender Singh; Kamal Kirti; Tarun Yadav
Abstract
Background: Hip fractures are one of the most frequently encountered complaints in both the young and elderly population. USG-guided peripheral nerve blocks help in early surgical fixation by providing perioperative pain relief and early mobilization.Methods: 60 patients of either sex, ASA 1 to 3, aged ...
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Background: Hip fractures are one of the most frequently encountered complaints in both the young and elderly population. USG-guided peripheral nerve blocks help in early surgical fixation by providing perioperative pain relief and early mobilization.Methods: 60 patients of either sex, ASA 1 to 3, aged 18-65, scheduled to undergo surgery for hip fracture, were randomly allocated into two groups. Group P received a USG-guided PENG block, and Group F received an FIC block. Results: In the PENG group, 26(86.7%) patients showed grade 1 positioning, 3(10%) patients showed grade 2, and 1 patient showed grade 3 positioning. In the FICB group,11(36.7%) patients showed grade 1 positioning, 17(56.7%) patients showed grade 2, and 2 patients showed grade 3 positioning. Grade 1 (86.7%) was higher in the PENG group, while grade 2 (56.7%) was higher in the FICB group.Conclusion: PENG block provides better analgesia and better quality of positioning during spinal anaesthesia than FIC block.
Research Paper
Head and Neck
Layth Mohammed Alsalim
Abstract
Background: EMG assessment has also been applied to study differences between asymptomatic subjects and those suffering from various forms of craniofacial muscle-related dysfunctional symptoms. Aim of Study: To assess application of EMG study of masticatory muscles. Materials and methods: This clinical ...
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Background: EMG assessment has also been applied to study differences between asymptomatic subjects and those suffering from various forms of craniofacial muscle-related dysfunctional symptoms. Aim of Study: To assess application of EMG study of masticatory muscles. Materials and methods: This clinical study included 10 patients, 6 males and 4 females, who were 8 – 62 years old. The mandible has been immobilized for about 5 to 6 weeks. The masseter muscle and anterior fibers of temporalis muscle were chosen as evaluation sites. Results: Thirty-six muscles were taken for EMG analysis, right temporalis (8 muscles, 25%), left temporalis (8 muscles, 25%), right masseter (8 muscles, 25%), left masseter (8 muscles, 25%). Fifty-three percentage of the taken muscles showed positive sharp waves after analysis of the EMG reading. 7 muscles of grade 1, and 10 muscles of grade 2 Fibrillation of taken muscles 16% showed fibrillation potential was seen with grading from 1+ to 4+ Mean MUP duration of temporalis muscles of the examined cases is increased (12.9 ± 6) and the calculated P value is 0.018 (<0.05). Conclusion: MUP onset interval (OI) is a good marker for follow up of muscles in such immobilized cases. Significant decrease in difference of the MUP onset interval (OI) give a picture that the changes occur during period of immobilization are a neuropathic more than myopathic processes. The increase in MUP duration indicates there is increase in number of affected motor units, and this change is of neuropathic. Positive sharp wave and fibrillation potential can be evaluated as indicators of facial muscles acute denervation due to immobilization.
Research Paper
Anaesthesia and Intensive Care
halah tahseen alkhalidy
Abstract
Treatment of postoperative pain is one of the concerns of all anesthesiologist since inguinal hernia repair surgery is more done as day case surgery so treatment of postoperative pain is crucial since can reduce hospital stay, improve mobilization and patient satisfaction. Transvers abdomens plane block ...
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Treatment of postoperative pain is one of the concerns of all anesthesiologist since inguinal hernia repair surgery is more done as day case surgery so treatment of postoperative pain is crucial since can reduce hospital stay, improve mobilization and patient satisfaction. Transvers abdomens plane block and ilioiguinal ,iliohypogastric nerves block are two different methods by ultrasound guide required anesthesia used to treat postoperative pain.
Research Paper
Medicine
mais razaq jaafar; HASSANIN KAREEM HASAN
Abstract
ABSTRACTBackground: 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: To evaluate the effectiveness and safety of peripheral nerve stimulation ...
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ABSTRACTBackground: 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: To evaluate the effectiveness and safety of peripheral nerve stimulation combined with pulse radiofrequency in the management of brachial plexus injury.Patients and method: A clinical therapeutic trial was carried out in Baghdad, Iraq, between the first of April to the first of October 2024. A convenient sample of 50 patients aged 18 years or older with brachial plexus injury was included in the present study. The intervention was done in two sessions at three months intervals and included nerve stimulation, including sensory and motor stimulation, followed by pulse radiofrequency at the same time for the brachial plexus roots.Results: The proportion of patients experiencing sensory impairment significantly declined after the first session (P-value = 0.001) and showed a further significant reduction following the second session compared to the first. According to the electromyography assessment and clinical examination, the proportion of patients with severe motor injury significantly decreased after the first session (P-value<0.01). Then, it significantly decreased after the second session compared to the first session (P-value<0.01). In addition, 32 (64.0%) patients had functional recovery after the second session. An improvement was obtained in the pain after the first session and after the second session compared to the first session (P-value=0.001 for both).Conclusion: Pulsed radiofrequency combined with nerve stimulation offers an effective and safe approach to treating functional disabilities caused by peripheral nerve injuries, including injuries to the brachial plexus. These methods are also effective for managing pain associated with such injuries.Keywords: Pulsed radiofrequency, nerve stimulation, brachial plexus injury
Research Paper
Anaesthesia and Intensive Care
Manal Mahdi Jawad
Abstract
Background: Regional nerve block techniques offer a great degree of postoperative pain relief. Recently, the transabdominal plane (TAP) block has been utilized to put people to sleep for surgery on their abdomen and pelvis.Aim: This study aimed to evaluate the effectiveness of ultrasound-guided TAP block ...
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Background: Regional nerve block techniques offer a great degree of postoperative pain relief. Recently, the transabdominal plane (TAP) block has been utilized to put people to sleep for surgery on their abdomen and pelvis.Aim: This study aimed to evaluate the effectiveness of ultrasound-guided TAP block compared to intramuscular tramadol for postoperative pain relief following cesarean section.Patients and method: A comparative clinical trial study was conducted during the period from January 1 to April 30, 2025. The study included 200 patients who underwent elective cesarean section under general anaesthesia. Patients were randomly allocated TAP block group which included 100 patients who received an ultrasound-guided TAP block and tramadol injection group included 100 patients who received intramuscular tramadol. The data included patients registered pain scores at 1, 2, 4, 6, and 8 hours after surgery, the need for a second dose of analgesia, and the incidences of nausea and vomiting.Results: The mean Visual Analogue Scale (VAS) was significantly lower in the TAP block group compared to the tramadol injection group at 1, 2, 4, 6, and 8 hours postoperatively. The incidences of nausea and vomiting were significantly lower in the TAP block group than in the tramadol injection group.Conclusion: The TAP block is more effective than intramuscular tramadol in reducing postoperative pain with fewer side effects. The TAP block is suggested to be used as part of multimodal approaches in the prevention and management of postoperative pain for patients undergoing cesarean section.
Research Paper
Medicine
Rand Saadi Abdulsattar; Hassanin Kareem Hasan
Abstract
AbstractBackground: Neuromodulation alters nerve activity by implanted electrodes that provide regulated electrical pulses, with adjustable parameters including the width, frequency, and amplitude of the pulse.Aim: To evaluate the efficacy and safety of caudal epidural analgesia compared to peripheral ...
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AbstractBackground: Neuromodulation alters nerve activity by implanted electrodes that provide regulated electrical pulses, with adjustable parameters including the width, frequency, and amplitude of the pulse.Aim: To evaluate the efficacy and safety of caudal epidural analgesia compared to peripheral nerve stimulation for alleviation of pain and paresthesia.Patients and Method: A clinical therapeutic interventional trial study was undertaken between January and December 2024. The study registered 80 patients who were diagnosed with dibatic peripheral neuropathy were enrolled in the current study. Those patients were categorized into two groups: Group A comprised 40 patients receiving caudal epidural stimulation treatment; Group B comprised 40 patients receiving peripheral nerve stimulation treatment.Results: In both groups, there was a significant number of patients who got sensory improvement after intervention. In both groups, there was significant pain improvement as revealed by the visual analogue scale (P-values were 0.001 for both). After the second session, the patients in group A had a significantly higher improvement in sensation (P-value=0.023), paresthesia (P-value=0.033), and pain (P-value=0.007) than patients in group B.Conclusion: Both caudal epidural nerve stimulation and peripheral nerve stimulation are safe and active approaches in the treatment of peripheral neuropathy but caudal epidural nerve stimulation is more effective regarding sensory sensation, paresthesia, and pain sensation than peripheral nerve stimulation.
