Print ISSN: 2706-6207

Online ISSN: 2664-3154

Volume 17, Issue 2

Volume 17, Issue 2, Summer and Autumn 2021, Page 46-82

Surgical Care and Resident Education during COVID-19 Pandemic

Raid M. Al-Ani .; Amer Fakhree AL-Ubaide .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 2, Pages 49-54
DOI: 10.33091/amj.2022.171069

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 a 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.

Rhinomanometric Evaluation of Patients with Nasal Obstruction Before and After Nasal Surgery

Thenoon Y A. Alkuder .; Husam H. Salman .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 2, Pages 55-58
DOI: 10.33091/amj.2022.171070

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 measurementof 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 BasrahTeaching Hospital on 23 patients who prepared for nasal surgeries to improve their nasal obstructioncomplain. The study was covered the period of the 2004 year. The anterior rhinomanometry wasdone for all patients preoperatively (with and without decongestant) and post-operatively withoutdecongestant.Results: Out of 23 patients, 15 (65.2%) were males. The age ranged from 17 to 45 years witha mean of 25.5 years ± 7.019. The most common associated symptom with nasal obstructionwas 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 showedrhinomanometric improvement (P-value = 0.002). There was no statistically significant differencebetween 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 clinicalevaluation of the patients with nasal obstruction.

Correlation of Testicular Volume and Semen Parameter with Varicocele Grades in Mosul City: A Case-Control Study

Asaad I Othman .; Nabeel M Al-Hamamy .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 2, Pages 59-63
DOI: 10.33091/amj.2022.171071

Background: Varicocele is a status of abnormal dilatation and sinuosity of the pampiniformplexus 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 wasconsidered as one of the surgically correctible causes of male infertility.Objectives: The objective of the current study was to investigate the correlation of testicularvolume and semen parameter with varicocele grades in patients with varicocele attending theDepartment of Urology of Al-Jumhory Teaching Hospital.Materials and methods: The current study was a case-control study which was conducted inthe Department of Urology at Al-Jumhory Teaching hospital, Mosul city, Iraq, during the periodJanuary 2018 to June 2019. A total of 250 participants were enrolled in this study (200 patientswith clinical varicocele and 50 healthy volunteers). Seminal fluid analysis, testicular size measuredby ultrasound scanning, and varicocele grading according to standard criteria based on clinicalexamination and Doppler study of genitalia were performed for all participants. Statistical analysiswas applied to test the correlation of testicular size and seminal fluid parameter with varicocelegrade.Results: Patients with varicocele were classified into three groups based on the grade of varicocele:Group I included 22 patients with Grade I varicocele (12%), Group II included 82 patients withGrade 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 normalmotility and morphology were 33% and 32%, 25% and 25%, 10% and 15%, 60% and 65% in groupI, 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 asdecreased ipsilateral testicular volumes compared to men with small varicocele or healthy men.

Diagnosis of Pulmonary and Extra-pulmonary Tuberculosis: Role of Adenosine Deaminase Levels in Different Body Fluids

Saleem O. Almawla .; Ossama I. Rahiem .; Rami B. Ayous

Al- Anbar Medical Journal, 2021, Volume 17, Issue 2, Pages 64-67
DOI: 10.33091/amj.2022.171072

Background: Tuberculosis (TB) is one of the major public health problems, particularly indeveloping countries. There are many tools to diagnose TB, one of them is the estimation of thelevel of adenosine deaminase (ADA) in various fluids in the body.Objectives: To find the role of ADA levels in 4 different types of body fluids to diagnose TB andextra-pulmonary TB.Materials and methods: This prospective study was conducted in the 3 main hospitals in Anbargovernorate, Iraq for one year from July 2019 to June 2020. Four types of body fluids [serumsamples, pleural fluid, ascetic fluid, and cerebrospinal fluid (CSF)] were collected from patients whowere suspected of having TB. The levels of ADA were measured by ELISA. An accurate diagnosisof TB was done by Genexpert real-time polymerase reaction (PCR). The results were comparedaccording to PCR findings.Results: Out of 176 patients, there were 31 patients were proved to be positive, for TB byGenexpert real-time PCR. The highest mean level of ADA in positive TB cases by PCR was inthe pleural fluid (58.258 ± 2.707), and the last was in the serum. There was a highly statisticallysignificant difference between the ADA levels in all 4 body fluids between the positive and negativeTB cases (P-value= 0.000). In the positive cases, the sensitivity of ADA levels in the serum, CSF,pleural fluid, and ascetic fluid were found to be 40%, 81%, 96%, and 94% respectively and thespecificity was found to be 88%, 72%, 94%, and 90% respectively.Conclusion: The ADA levels in all 4 body fluids were highly statistically significant differencebetween TB negative and positive cases diagnosed by PCR. However, they had different sensitivityand specificity levels.

Lactose Free-Milk for Young Children with Acute Diarrhea, Western of Iraq

Wisam Z. Al-Dulaimy .; Mohammed K. Al-Sabeea .; a, Muneam A. Ayyed .; Rafi Khaleel Al-Ani .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 2, Pages 68-71
DOI: 10.33091/amj.2022.171073

Background: Secondary lactose intolerance occurs commonly from intestinal inflammationfollowing infection recommending avoidance of milk contains lactose.Objectives: To identify the role of lactose-free milk (LFM) in the treatment of acute diarrhea inchildren ≤ 2 years in Al-Ramadi Maternity and Childhood Teaching Hospital in Ramadi city, Iraq.Materials and methods: This A single-blind randomized controlled trial study was done onbabies ≤ two years old who presented with acute diarrhea. Two hundred cases were chosenrandomly, 100 of them were received LFM added to the regime of management of diarrhea (groupA), and the other 100 cases were received ordinary formula milk (OFM) (group B). Babies whowere breastfeeding, those with chronic or bloody diarrhea, and those who received antibiotics wereexcluded from this study. Data about age, gender, the response ( stopping diarrhea), and itsduration within 3 days were recorded.Results: The response of stopping diarrhea after 3 days among group A was 89%, while groupB 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%) whorespond to therapy, and it was the highest age group affected. There was a high statisticallysignificant 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 responserate. Moreover, there was no significant difference (P-value > 0.05) between the rate of responseand 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 acutediarrhea after giving LFM in comparison with OFM.

Histological and Biochemical Evaluation of the Effect of Desloratadine Drug in Parotid Gland Tissues

Intesar J. Mohammed .; Entedhar R. Sarha .; Siham A. Wadee .; Salwa M. Al-Shiakhani .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 2, Pages 72-77
DOI: 10.33091/amj.2022.171074

Background: The functional deterioration of salivary glands is a consequence of a wide range offactors and significantly interfered with life quality. Desloratadine (an antihistamine) is among thedrugs listed to cause dry mouth; however, its effect on major salivary gland tissues has not beenwell studied.Objectives: To evaluate the effects of desloratadine treatment on parotid gland tissues, histologicalfeatures, 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 desloratadineat 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 sacrificedand five µm formalin-fixed paraffin-embedded tissue sections were prepared routinely from parotidglands for histological evaluation under light microscope.Results: The histological evaluation of salivary gland tissues in both treated-groups was revealeda remarkable cytoplasmic vacuolization, atrophy, and degranulation in acinic cells. The serousacinar cells were showed autolysis and nuclear changes (pyknosis, karyorrhexis, and karyolysis).There was an increase in the interstitial spaces between each parenchymal element associatedwith few mononuclear cell infiltrations. The intra-lobular ducts were reduced in size and wereindistinct throughout lobes. The severe changes were associated with higher desloratadine dose.Regarding biochemical analysis, the treated-groups had significantly increased serum levels ofmalondialdehyde, sialic acid, lactate dehydrogenase and creatin kinase, and significantly reducedserum levels of superoxide dismutase, catalase, and glutathione.Conclusion: Desloratadine administration produces noticeable histological changes in a dosedependent manner associated with increased oxidative stress markers and decreased antioxidativeactivity.

Acute Appendicitis in Situs Inversus Totalis: A Case Report and Review of Literature

Ali Mahdi Al-Tamim .; Sami M. Al-Rubaye .; Mansoor Idan Al-Zubaidi .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 2, Pages 78-80
DOI: 10.33091/amj.2022.171075

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