Basrah Journal of Surgery

Iraq''''''''s healthcare system was once considered one of the best in the region, with extensive infrastructure and skilled medical professionals. However, decades of war, sanctions, and political instability have taken a toll on the system. We compared the research output and country ranking of Iraq in ‘Surgery’ and ‘Orthopedics and Sports Medicine’(OSM and compared with the other Arab nations in these fields. Iraq witnessed a significant rise in the number of yearly publications in Surgery from only 2 in 1996 to 205 in 2022. The maximum publication surge was noticed in the last decade. During the cumulative period from 1996 to 2022 (27 years), there are a total of 938 publications in the SCImago database, accounting for 3.48% of 21 Arab nations, and ranking 8th amongst them. Whereas, in OSM, from 1996-2022, there were a total of 160 publications, with the 10th rank amongst 20 Arab nations. We believe that Iraq can restore its past glory of the 1970s by working towards building a more resilient and equitable healthcare system that meets the needs of its population, through their research on locally prevailing healthcare problems.

In this review paper we have discussed the evolution of ring external fixators over time and the development of newer technologies
we also included review of some literature The aim of this review is to highlight the mechanical differences and the overall outcome whether following deformity correction or treatment of compound fractures between the different versions of ring fixators as well as a comparison between uniplanar and ring external fixators for management of compound fractures.

Background Coronary artery disease (CAD) is a very common disease with its incidence steadily rising worldwide. The study aims to show our experience in management of CAD using coronary artery bypass grafting (CABG).
Methodology This retrospective study enrolled all patients who underwent CABG surgery in Sulaimani during 2023 whose medical files could be accessed. The patients were operated upon in Sulaimani Cardiac Hospital (SCH) (Public) and Anwar Sheikha Medical City (ASMC) (Private). Patients’ medical files were reviewed, pertinent data was entered into a Microsoft Access database and the results were analyzed and statistically tested thereafter.
Results CABG accounted for 59.2% of total procedures. The patients' ages ranged from 35 to 81 years, with a mean age of 59.6, and the majority were males (76.9%). The top risk factors were hypertension (55.8%) and diabetes mellitus (48.5%). Common symptoms included chest pain (72.3%) and dyspnea (53.1%). Most patients had multivessel CAD (89.0%) and a normal ejection fraction (74.7%). CABG was the primary procedure in 91.3%, accompanied with other surgeries in 8.7%, with mitral valve surgery being the most common additional procedure (5.9%). The study noted that left internal mammary artery (LIMA) and great saphenous vein (GSV) were the main grafts used. Majority (88.5%) of patients experienced no complications post-surgery, with median sternotomy wound infection being the most common complication. The average hospitalization period was 4.48 days, longer in private hospitals than in public ones. The study reported a 2.7% mortality rate within 30 days, which was significantly higher in the public hospital, among females, and those with lower preoperative ejection fractions. Prior PCI and concomitant surgeries had no statistically significant impact on the mortality.
Conclusions CABG surgery is a time-tested safe and effective therapy for CAD. The annual rate, complications and mortality of CABG in this series were comparable to other studies.

Background:
Genitourinary tuberculosis is a popular health disease prevalent in the Indian scenario. Early diagnosis is crucial to prevent its progression to renal failure . This study presents the experience of surgical intervention of genitourinary tuberculosis cases in a tertiary care hospital.
Materials and Methods:
Fifty patients of both genders undergoing elective surgical intervention for GUTB between Febraury 2022 and May 2023 were prospectively recruited in this study. The preoperative and postoperative investigations were done as per the institutional protocol.
Results:
In this study of 50 patients, more number of males (26) suffered from GUTB than females (24). Sixty percent of the patients were aged between 20 and 40 years. The mean age was 46.14 ± 10.16years. Imaging studies of the urinary system were abnormal in 80% of the patients with hydronephrosis being the most frequent presentation. Flank pain was the most common symptom experienced in 39 cases. The ureter was the most commonly involved organ (29 patients) for whom surgical intervention was performed, followed by kidney (12 patients) and bladder (9 patients). Psoas abscess compounding to the kidney involvement was seen in 2 cases . PUJ-associated obstruction was involved in 4 cases . One patient presented with tuberculosis in the left ovary with a colovesical fistula.
Conclusion:
Diagnosis of GUTB can be confounding, compelling a high index of suspicion owing to the paucibacillary load, in the biological specimens and the difficulty in isolating or culturing TB bacilli. Hence, a strong clinical suspicion is essential for the correct and early diagnosis and delay diagnosis of genitourinary tuberculosis may result in major organ damage necessitating either organ removal or reconstructive surgeries. The first line of medical treatment of multidrug chemotherapy should be supplemented with judicious surgery (as indicated) as the ideal management for restoration of the genitourinary tract function

Background: Pulmonary aspiration is a constant risk in patients planned for anesthesia and those who are critically ill. Ultrasonic examination of the stomach gives a valuable assessment opportunity to predict gastric residual volume. Involvement of non-radiologists for its estimation can potentially prevent lots of incidences of aspiration and consequently pulmonary complications and even deaths. Both the duration required for the training and the examination period for estimation, are still to be studied.Objectives: This study tries to illustrate the consistency of measurements of gastric antral area among three anesthesia trainees as novice sonographic readers with a short training course and to measure the applicability of lowering the examination time to two minutes in both semi sitting (Fowler`s) position and right lateral recumbent position.Design: Prospective study at a tertiary teaching hospital. Patients included are in intensive care unit with a nasogastric feeding tube. Three anesthesia trainees with equal training courses in the subject were recruited and have their sonographic evaluation compared in two patients positions. They all are blinded to time, type, and volume of last enteral intake.Results: The readings reported by the three doctors in either lateral or supine positiondid not show significant statistical differences (P value >0.05). Consistency of thereadings among the three doctors was high (Cronbach’s alpha = 0.926).Conclusion: Anesthesiologists with short term appropriately performed courses canuncover the risk of gastric contents regurgitation and aspiration with only a two minute bedside gastric sonographic examination.

Background: Chest X-rays are routinely requested for almost all preoperative patients in our local hospitals, regardless of their medical history, clinical examination, or clear indications. This practice is often justified by the belief that it can help stratify risk, guide anesthetic choices, or influence postoperative management. However, this high demand for chest X-rays places an excessive burden on healthcare system resources, increases exposure to ionizing radiation, and elevates the risk of false-positive findings.Objective: it is to assess the prevalence of incidental findings on preoperative chest X-rays in our city and their impact on surgical decision-making.Methods: This cross-sectional observational study included 260 patients admitted for elective non-cardiopulmonary surgery who underwent preoperative chest X-rays. We systematically analyzed each chest X-ray for abnormalities and classified them as either normal or abnormal. We also determined the consequences of these findings on the intended surgery (proceed to surgery, specialist referral before surgery without postponing the operation, or postponing the surgery).Results: Out of the total chest X-rays included in the study, 229 (88.1%) were reported as normal, and only 31 (11.9%) showed abnormalities. When assessing the impact on the decision to proceed with surgery, 257 (98.8%) of the patients underwent surgery without delay. For those with abnormal chest X-rays, they received specialist consultations without postponing their intended surgery. Only 3 patients (1.2%) experienced delayed surgery, and none of them had significant lung field abnormalities on their chest X-rays. The delays were attributed to other reasons.Conclusion: The use of chest X-rays should be justified on a case-by-case basis and limited to indicated patients based on thorough medical history and clinical examination, in alignment with published international guidelines. This approach will increase the efficacy of the healthcare system, reduce unnecessary costs, and ultimately enhance the safety and benefit for the patient.

Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are widely performed surgical procedures aimed at relieving pain and restoring function in patients suffering from advanced osteoarthritis or other degenerative joint diseases. Pregabalin and Celecoxib, two medications with distinct mechanisms of action, have emerged as valuable components in multimodal analgesic strategies for TKA and THA. We explored the combined effect resulting from the utilization of Pregabalin and Celecoxib in the context of TKA and THA, focusing on their benefits in improving postoperative pain management. Patients and Methods: We enrolled 87 patients who had TKA and THA between January 2022 and November 2023; they were divided into two groups: The Pregabalin + Celecoxib (group Ⅰ) and the Celecoxib alone (group Ⅱ). Two weeks before surgery, each group received an individualized preventive analgesia regimen. Following surgery, the groups' pain scores and side effects were assessed and compared. Results: The mean pain score of group Ⅰ was significantly lower than the mean pain scores of (group Ⅱ) at both 6 (P=< 0.001) and 12 (P=< 0.001) hours postoperatively. Eight cases of dizziness were observed in (group Ⅱ). Conclusion: Celecoxib and Pregabalin both before and following TKA and THA reduced pain and enhanced physical function more than Celecoxib alone.

Abstract:Background: The growing problem of medication usage has drawn attention worldwide, especially among those who take over-the-counter medications to treat nasal-related problems. In this study, we sought to investigate the use of topical nasal medicines and to throw light on consumers' knowledge, and behaviors regarding nasal decongestant self-medication. The study aims to assess their knowledge of required doses and probable adverse effects. The study will also look for knowledge gaps and patterns of usage in order to guide targeted educational initiatives and reduce the risk of decongestant overuse. Method: This is observational research at Basra governorate conducted through an online self-administered questionnaire. A sample size of 250 people was chosen randomly regardless their nasal decongestant use status, and data on demographics, awareness levels, and usage habits were collected. SPSS was used to analyze the data, and participants supplied informed consent while maintaining data confidentiality.Results: There were 46.4% males and 53.6% females among the 250 participants. In terms of age, (53.2 %) of participants were between the ages of 20 and 40, followed by 40-60 years old (37.2 %). 77.2% of participants had a high level of education. When asked if they use nasal decongestants, 37.2 % said they do, and 86.8% have used them in the past or presently do. In terms of drug knowledge, 28% of participants are aware of the adverse effects. 27% are aware of the medically suggested length of usage, and 30% are aware of nasal congestion addiction.Conclusion: the overall knowledge was low and increased with the level of education. Most of the patients were self-medicated

Background: A proper healthcare service can be provided by healthcare workers including physicians and paramedics with perfect mental health who are free from occupational stress. Stress can affect up to 60% of health care providers including physicians, advanced care providers, and nurses. The study aimed to measure the prevalence of work-related stress among resident doctors in Basrah city and to determine its determinants.Method: An observational cross-sectional study that had been conducted at Al Basrah center Hospital. Ninety-seven resident doctors were included. The doctors were interviewed through the usage of a special questionnaire, the Workplace Stress Scale (WSS) was used to assess the stress level among doctors.Results: Of the 97 resident doctors, the mean age was 31.04 years. More than half were females, 43% were at low stress, and those with severe stress formed only 10%. There is a significant association between the stress scale and age, gender, having children, Smoking status, work experience, working hours /week, night shift and work at the weekend since the p-value <0.05.Conclusion: more than half of the participants expressed some level of stress, and those with younger age, male sex, having children, smokers, with less work experience, higher working hours, working at weekends and having a night shift all had higher levels of stress.

Background: Anterior cruciate ligament (ACL) injuries are common, particularly among young, active individuals, and are associated with significant morbidity. Arthroscopic ACL reconstruction has become the gold standard for restoring knee stability and function, yet the optimal candidate and timing for surgery remain subjects of ongoing research. Patients and Methods: This descriptive follow-up study, conducted at Basra Teaching Hospital from October 2011 to January 2014, enrolled 35 male patients aged 18-65 years with confirmed ACL injuries. Participants underwent arthroscopic ACL reconstruction using hamstring and gracilis tendon grafts. Outcomes were assessed using the Tegner-Lysholm scoring system, focusing on knee function and stability, over one year post-surgery. Statistical analyses were performed using SPSS version 26, with significance set at p < 0.05. Results: The majority of participants (62.8%) were aged 21-30 years, with a mean age of 24.6 ± 2 years. Right knee injuries were more common (57.1%). Most injuries (82.8%) were sports-related, predominantly from contact sports (74.3%). Post-operatively, significant improvements were observed in knee stability tests: Lachman test positive rates dropped from 100% to 5.7%, Pivot Shift test rates from 71.4% to 5.7%, and Anterior Drawer test rates from 100% to 14.2% (p < 0.001). The Tegner-Lysholm scores showed substantial enhancement, with poor outcomes decreasing from 48.5% to 5.7% and excellent ratings increasing from 0% to 22.8% (p < 0.001). Professional athletes had better recovery outcomes (average score 91.7) compared to non-professionals (average score 79.9, p = 0.041). Complications were minimal, with infection and ACL failures each occurring in 5.7% of cases, and leg-foot paresthesia in 2.8%. Conclusion: Arthroscopic ACL reconstruction is effective in significantly improving knee function and stability among young, active males, particularly those engaged in professional sports. Early surgical intervention, coupled with tailored rehabilitation, is crucial in achieving optimal outcomes. These findings advocate for a proactive approach in managing ACL injuries