Iraqi National journal of Medicine

Background:


Laparoscopic sleeve gastrectomy is a well-known method for weight reduction. Post-operative weight loss is a major risk factor for gallstone formation.
Objective:


To determine whether prophylactic concomitant laparoscopic cholecystectomy should be performed on all patients at the time of laparoscopic sleeve gastrostomy or not.
Patients and Methods:


A retrospective and prospective study on 540 patients with morbid obesity who underwent laparoscopic sleeve gastrectomy; their BMI range was between 38 and 53, their age range was 18 to 63 years, and 335 of them were females. The exclusion criteria were patients with a history of cholecystectomy, gallstone patients or gallbladder polyps more than 1 cm in preoperative abdominal ultrasound, and those who failed to follow-up. All patients were followed up with every 6–12 months, including those who had cholecystectomy by other surgeons.
Results:


During the study period, from the total 540 patients who had laparoscopic sleeve gastrectomy, 167 patients (30.92%) had cholecystectomy, out of which 20 patients (3.7%) had achieved 45% weight reduction during the first six months; while in another 6 months, 147 patients (27.22%) had cholecystectomy, achieving additional 30% weight reduction.
Conclusions: The incidence of gallstones after laparoscopic sleeve gastrostomy is about 30.92%, indicating that 69.08% will not have gallstones in the postoperative follow-up period, so it would be unwise to do prophylactic concomitant cholecystectomy for all patients.
Keywords: Bariatric procedures, cholecystectomy, incidence

Background: Although it is not possible always, reconstruction of defects with tissue such as defect in the original tissue usually results in best functions and esthetic outcomes. Therefore, replantation of an amputated part is superior to any other method of reconstruction mainly when the condition of the amputated part is good. The goal of replantation after amputation is function. Returning of circulation to an amputated part does not, by itself, mean success. Therefore, replantation that will not lead to a useful activity should be avoided. This is usually the case with severely crushed and extensively avulsed limbs.


Objectives: evaluation of functions’ outcome after replantation.


Patients and Methods: This study deals with 18 patients (14 males, 4 females) with different injuries. Severely crushed and extensively avulsed limbs have been excluded from repair. The level of injury involved an arm in two patients, an elbow in one, a forearm in two, a palm in two, a thumb in two, and fingers in nine. The patients’ age ranged between 2 and 55 years, during the period between January 2012 and February 2016.


Results: In all the cases, replantation of the amputated part was successful; however, there were variations in functional recovery among the cases: in three cases, the functional recovery was very good, in five, it was good, in eight, it was fair, and in two, it was poor.


Conclusions: Replantation should be tried for most amputation cases, as it has a superior aesthetic and functional result and serves a major psychological benefit for the patients. High success in a rat can be achieved when one chooses to replant an amputated part in good condition, all the structures are repaired at the time of the primary operation, and there exist excellent post-surgery physiotherapy and good patient compliance.

Background: Ptosis is the drooping of the upper lid margin below its normal anatomic position due to the levator complex dysfunction. In this condition, the aesthetic and functional abnormality is obvious and is accompanied by severe visual field defect. Ptosis surgery is one of the most common oculoplastic procedures with different surgical procedures. The decision for an appropriate surgical procedure and the material used to minimize the incidence of complication depends on proper evaluation of the patient.


Aims of study: To evaluate Mehta\'s Modification of the Crawford technique for frontalis sling surgery with silicon rod in sever ptosis.


Patients and Methods: We considered 10 patients (12 lids) who were treated between February 2017 and June 2018. There were seven males and three females; two patients were bilateral and three patients had negative Bell\'s phenomenon, which was surgically treated with Mehta\'s modification of the Crawford technique for frontalis sling surgery with silicon rod. The patients’ age ranged from 4 to 30 years; they all had severe eyelid ptosis (>4mm) with poor levator function (≤4 mm).


Results: Our patients\' postoperative results were good, functional, and aesthetic, showing a clear visual field, with smooth and regular eyelid margin and no notching. Nine out of 10 patients achieved good results according to the above-mentioned criteria, and in addition to that, both patient and parents\' satisfaction were taken into consideration. Only one patient had developed recurrence (1- month postop.)


Conclusions: Mehta\'s modification of the Crawford technique for frontalis sling surgery with silicon rod in sever ptosis used for the treatment of severe ptosis with poor levator excursion is an easy and simple procedure that promises good postoperative results.

Background: Cataract is a condition where the clear lens of the eye becomes dull. Diabetes mellitus is well known disease that accelerate cataract progression. Cytokines are low molecular weight proteins that mediate the immune response. Low-grade chronic inflammation and activation of the innate immune system are strongly related to the diabetes mellitus pathogenesis. Interleukin-2 (IL-2), Interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and certain other chemokines are inflammatory mediators are influenced in the development of diabetes and its complications.


Objective: To evaluate and correlate the levels of inflammatory cytokines IL-2, IL-6 and TNF-α in the aqueous humor of eyes of diabetic and non-diabetic patients undergoing cataract surgery.


Patients and Methods: Seventy cataract patients (51 males and 19 females) were included, their ages ranging from 21 to 95 years. Intracameral cytokines IL-2, IL-6 and TNF-α were detected using ELISA.


Results: TNF-α significantly increased in the aqueous humor of diabetic patients more than in that of the non-diabetic ones (p-value < 0.05). The aqueous humor contained detectable IL-2 levels more frequently in diabetic patients. This difference was not statistically significant (p > 0.05). On the other hand, IL-6 was more frequently detectable in the eyes of the non-diabetic patients.


Conclusions: The distribution of cytokines in the aqueous sampling shows that TNF-α levels were higher in diabetic patients than in non-diabetic patients. On the other hand, IL-6 levels were higher in non-diabetic patients than in diabetic patients. With regard to IL-2, there was no significant difference.

Background: Kidney transplantation is considered the most effective therapy for end-stage renal disease (ESRD). Postoperative complications continue to occur in nearly 12–20% of patients. These complications can be sub-divided into three categories: vascular, urologic, and nephrogenic.


Objective: To determine the surgical and urological complications of renal transplant in Basra Training Center.


Patients and Methods: A prospective descriptive study was done on 71 patients who underwent renal transplant surgery between October 2015 and August 2018. After taking their informed consent, preoperative antibiotics were given, and the procedure was done under general anesthesia. In all the transplantations, the renal vein of the donor was anastomosed to the external iliac vein of the recipient with an end-to-side. While the renal artery anastomosed to the internal iliac artery of the recipient with an end-to-end for the first 50 cases, in the other 21 cases, renal artery anastomosed to the external iliac artery of the recipient with an end-to-side anastomosis. Ureters were anastomosed by the Lich–Gregoire procedure.


Results: Overall, urological and surgical complications were encountered in 12 of the renal transplants recipients from the total number (71, 17%). This study included a total of 71 patients (59 male and 12 female, 83% and 17%, respectively). The complications that occurred during the follow-ups of the patients were as follows: one patient developed urinary leak (1.4%), five patients developed lymphocele (7%), four patients complained of acute pyelo nephritis (6%), one patients (1.4%) complained of wound infection, and one complained of renal stone (1.4%).


Conclusions: In conclusion, urological complications such as lymphocele (7%) and acute graft pyelonephritis (AGPN) (6%) remain the most common type of surgical complications following kidney transplantation (in this study). Our urological and surgical complication rate was relatively low compared to others noted in the literature.

Background: There is a correlation between anti-mullerian hormone (AMH) and the age when it becomes undetectable during menopause. The AMH immunoassay has been widely estimated in clinical practice to assist in reproduction and infertility treatment.





Objective: To investigate the normal level of serum anti-mullerian hormone (AMH) in relation to women’s age in Basra.





Patients and Methods: Cross-sectional study was carried out in Basra Maternity and Child Hospital from January 2018 to September 2019. Serum AMH levels were estimated for 975 women aged 15–50 years. They were classified into 7 age groups:15–20, 20–25, 25–30, 30–35, 35–40, 40–45 and 45–50 years. Serum AMH and FSH levels were determined by commercial enzyme-linked immunoassay.





Results: Negative relationship was noticed between AMH concentration and age. The mean AMH levels for the age groups 1, 2, 3, 4, 5, 6 and 7 were 4.9 ng/ml, 4.25ng/ml, 3.27 ng/ml, 2.43ng/ml, 2.17ng/ml, 1.95ng/ml and 0.9ng/ml respectively.





Conclusions: This study recorded normal levels of AMH in women in Basra. These levels can be considered for the medical treatment of infertile women.

Background: Breast cancer is very common in Basrah, Iraq and at global level. To assist in the control measures of breast cancer, good knowledge of women about certain aspects of the disease is essential and needs enhancement.


Objective: To explore the extent to which women have knowledge of breast self-examination (BSE), mammography, risk factors, and preventive measures for breast cancer.


Methods: A cross-sectional study involving 300 women in Basrah was conducted. The data collection form was used to interview participants from attendants of breast cancer early detection clinic, primary health care centers, and a private clinic. The data covered demographic characteristics of the women, their knowledge of BSE, mammography, risk factors, and preventive factors. The data were fed into the Statistical Package for Social Science (SPSS-Version 26). The results were expressed as frequency and cross tabulation. The Chi-squared test (or Fisher Exact Test) was used to examine the association between the groups, and a p-value of ≤ 0.05 was considered as statistically significant.


Results: Of the 300 participating women, 61.7% were married, 41.7% had secondary and higher level of education, and 75.6% were of the age of 30 and above. Family history as a risk factor for breast cancer was reported by 16.7% of the participants. About 90.3% of the participants had knowledge of BSE; however, only 42% knew about mammography. Only 38.3% and 11.3% of the participants had performed self-examination and mammography screening, respectively. In general, this study’s results revealed a moderate level of knowledge and practice.


Conclusion: A tangible gap in knowledge is evident and demands effective an health-education program to support breast cancer control efforts.

Background: Neonatal mortality accounts for nearly half of the deaths of children under the age of five, the main leading causes for which are respiratory distress, infection, and congenital anomalies. Action plans, which call for the elimination of preventable deaths of newborn babies, set specific targets to reduce neonatal mortality. This retrospective descriptive study was conducted in the Basra Teaching Hospital for maternity and childhood from January 2019 to February 2020, including all the neonates who were admitted in the first and second neonatal care units of the hospital.


Aim: This study aims to study the main causes of neonatal deaths in newborn babies in the neonatal care units at the main maternity and pediatric hospital of the Basra government.


Patients and methods: A total of 716 neonatal deaths were registered along with days of life before death and the cause of death; the cases were classified as early (1–6) days death and late (7–28) days death.


Results: In this study, we found that the main causes of early neonatal death were respiratory distress syndrome (68.4%), congenital anomalies (11.4%), infection (10.9%), birth asphyxia (7.2%), and other neonatal conditions (inborn error of metabolism, hemorrhagic disease of newborn, severe anemia, and unspecified causes) (2.1%), while for late neonatal death, respiratory distress (27.2%), congenital problems (17.7%), infection (45.6%), birth asphyxia (6.1%), and other conditions (3.4%) were cited.


Conclusions: It is important to direct the health resources towards preventable causes of neonatal deaths both before, during and after the delivery of a baby when the higher risk factors are preventable (prematurity, birth problems, and sepsis). Using all available resources to decrease preterm labors and mother education toward pregnancy and to improve the facilities and quality of neonatal care at the delivery room and neonatal care units.