Al- Anbar Medical Journal

COVID-19 pandemic is nearly affecting all surgical activities including providing a surgical care to the patients as well as a negative impact on the educational program of the resident doctors in nearly all surgical specialties. During this period, surgeons set out to find an effective solution to deal with patients who visit outpatient surgical clinics or emergency units especially those who are infected or in contact with an infected individual. Moreover, the continuity of the educational program to the residents doctors and completion of the syllabus is an essential issue needs to be done in complete organized manner. The aims are to provide the best solution for them (surgical patients and resident doctors) as well as reducing the risk of the infection to other patients, residents, and healthcare staff. Telemedicine can act as a substitute to many in-person consultation, therefore, it aids in controlling the infection. Many studies and recommendations are tackling this vital issue among surgeons from different specialties across the globe. Despite minor variations among these, these studies serve the above-mentioned purposes. We highlight in this narrative review to give the surgeons an appropriate plan for dealing with suspected or infected COVID-19 surgical cases and to complete the surgical educational program of the resident doctors.

Background: Nasal obstruction is a common complaint in daily Otolaryngology practice. Rhinomanometric study is an objective tool for the evaluation of nasal obstruction.
Objectives: To evaluate whether a correlation exists between the rhinomanomatric measurement of nasal resistance, nasal airflow, and the subjective sensation of airflow, pre and postoperatively.
Materials and Methods: This study was conducted in the Otolaryngology Department at Basrah Teaching Hospital on 23 patients who prepared for nasal surgeries to improve their nasal obstruction complain. The study was covered the period of the 2004 year. The anterior rhinomanometry was done for all patients preoperatively (with and without decongestant) and post-operatively without decongestant.
Results: Out of 23 patients, 15 (65.2%) were males. The age ranged from 17 to 45 years with a mean of 25.5 years ± 7.019. The most common associated symptom with nasal obstruction was rhinorrhea (n=15, 65.2%). Only 12 cases were attended by the postoperative evaluation. Three-quarters of them were showed clinical improvement, but 4 patients (34%) were showed rhinomanometric improvement (P-value = 0.002). There was no statistically significant difference between the pre- and postoperative rhinomanometric values without decongestant and the subjective sensation (P-value>0.05).
Conclusion: The anterior rhinomanometry results didn’t add a significant value to the clinical evaluation of the patients with nasal obstruction.

Background: Varicocele is a status of abnormal dilatation and sinuosity of the pampiniform plexus that leading to a decrease in the volume of the impacted testicle. Approximately 15–20% and 35% of healthy adult males and men with primary infertility are affected respectively. It was considered as one of the surgically correctible causes of male infertility.
Objective: The objective of the current study was to investigate the correlation of testicular volume and semen parameter with varicocele grades in patients with varicocele attending the Department of Urology of Al-Jumhory Teaching Hospital.
Materials and Methods: The current study was a case-control study which was conducted in the Department of Urology at Al-Jumhory Teaching hospital, Mosul city, Iraq, during the period January 2018 to June 2019. A total of 250 participants were enrolled in this study (200 patients with clinical varicocele and 50 healthy volunteers). Seminal fluid analysis, testicular size measured by ultrasound scanning, and varicocele grading according to standard criteria based on clinical examination and Doppler study of genitalia were performed for all participants. Statistical analysis was applied to test the correlation of testicular size and seminal fluid parameter with varicocele grade.
Result: Patients with varicocele were classified into three groups based on the grade of varicocele: Group I included 22 patients with Grade 1 varicocele (12%), Group II included 82 patients with Grade II varicocele (38%), and Group III included 96 patients with Grade III varicocele (50%). Besides, Group IV was assigned to healthy volunteers (50) as a control group. Sperms with normal motility and morphology were 33% and 32%, 25% and 25%, 10% and 15%, 60% and 65% in group I, group II, group III, and group IV respectively. There were significant statistical differences (P-value<0.05) between the testicular volumes of both Group II and Grade III and control groups.
Conclusion: Men with large varicocele had significantly abnormal semen parameters as well as decreased ipsilateral testicular volumes compared to men with small varicocele or healthy men.

Background: Secondary lactose intolerance occurs commonly from intestinal inflammation following infection recommending avoidance of milk contains lactose.
Objective: To identify the role of lactose-free milk (LFM) in the treatment of acute diarrhea in children , 2 years in Al-Ramadi Maternity and Childhood Teaching Hospital in Ramadi city, Iraq.
Results: The response of stopping diarrhea after 3 days among group A was 89%, while group B was 67%. There was a highly statistically significant difference between the 2 groups (P-value = 0.001). Out of 44 babies in the age group 0-6 months in group A, there were 42 (95.4%) who respond to therapy, and it was the highest age group affected. There was a high statistically significant difference (P-value = 0.003) between the rate of response and the age group in group A. However, there was no significant difference (P-value > 0.05) between the gender and the response rate. Moreover, there was no significant difference (P-value > 0.05) between the rate of response and the age and gender of the babies in group B. There was a statistically significant difference (P-value<0.05) between group A and B concerning the mean duration of response (55.06 hours , 11.304 in group A, and 63.58 hours , 8.727 in group B).
Conclusion: There were a high response rate and rapid response among young children with acute diarrhea after giving LFM in comparison with OFM.

Background: The functional deterioration of salivary glands is a consequence of a wide range of factors and significantly interfered with life quality. Desloratadine (an antihistamine) is among the drugs listed to cause dry mouth; however, its effect on major salivary gland tissues has not been well studied.
Objectives: To evaluate the effects of desloratadine treatment on parotid gland tissues, histological features, and their impact on serum oxidative and antioxidant markers.
Materials and Methods: Thirty rats were used in this study. They were divided into three groups (each containing ten rats). Group A: control rats. Group B and C have received desloratadine at dose 0.142 and 0.245 mg/kg of body weight respectively for three weeks. After three weeks, serum levels of sialic acid, malondialdehyde, catalase, lactate dehydrogenase, superoxide dismutase, creatin kinase, and glutathione were estimated for three groups. Then, animals were sacrificed and five µm formalin-fixed paraffin-embedded tissue sections were prepared routinely from parotid glands for histological evaluation under light microscope.
Results: The histological evaluation of salivary gland tissues in both treated-groups was revealed a remarkable cytoplasmic vacuolization, atrophy, and degranulation in acinic cells. The serous acinar cells were showed autolysis and nuclear changes (pyknosis, karyorrhexis, and karyolysis). There was an increase in the interstitial spaces between each parenchymal element associated with few mononuclear cell infiltrations. The intra-lobular ducts were reduced in size and were indistinct throughout lobes. The severe changes were associated with higher desloratadine dose. Regarding biochemical analysis, the treated-groups had significantly increased serum levels of malondialdehyde, sialic acid, lactate dehydrogenase and creatin kinase, and significantly reduced serum levels of superoxide dismutase, catalase, and glutathione.
Conclusions: Desloratadine administration produces noticeable histological changes in a dose-dependent manner associated with increased oxidative stress markers and decreased antioxidative activity.

Acute appendicitis is the most common surgical condition seen in the emergency unit. In most cases, the diagnosis is straightforward, but sometimes maybe not easy as it may be presented in an atypical manner like unusual pain in the left iliac fossa. A 10-years-old boy was presented with an acute abdomen started in the periumbilical area and thereafter, shifted to the left iliac fossa. Chest X-ray and abdominal CT scan was confirmed the diagnosis of acute appendicitis with situs inversus totalis (SIT). Conventional appendectomy was performed with a good outcome. In addition to the detailed history and proper examination, a high index of suspicion and radiological investigations are mandatory to diagnose acute appendicitis in subjects with SIT.