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Article
Acquired Error in using Antibiotic for Surgery Patients in Iraqi Hospitals

Author: Fadya Y. Alhamdani فادية يعقوب الحمداني
Journal: Iraqi Journal of Pharmaceutical Sciences المجلة العراقية للعلوم الصيدلانية ISSN: 16833597 Year: 2011 Volume: 20 Issue: 2 Pages: 102-105
Publisher: Baghdad University جامعة بغداد

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Abstract

The use of antibiotics (AB) in surgery focused in either treating established infection or to prevent suspected post-operative infection. Inappropriate use of antibiotic for treatment of patients with common infections is a major problem worldwide, with great implications with regards to cost of treatment and development of resistance to the antimicrobial agent. Moreover, antibiotics may often be dispensed without a clear clinical indication. This study was conducted to estimate the medication errors in using antibiotic for surgery patients which may effect their wound healing. A 260 patients with clean-contaminated and contaminated surgery were included from two teaching hospitals, 160 patient from Medical city hospital and 100 from Al-kadhimiya hospital, 86% were female and 32% were male, their age range was 40 +/- 15. The study shows that there are medication errors related to different causes: firstly, medical team error which include the nurse (70.9%) and the physician which include 1) delay in patient follow up after operation(5.9%) , 2) changing the AB without doing culture and sensitivity test (48.8%), and incomplete prescription order(13.1%). second: ordering error which include: 1) the absent of original source of AB (44.5%), 2) Error in availability of the chosen AB (74.8%), and third: error related to the patient itself include 1) socioeconomic situation (14.5%), 2) educational state (54.3%), finally error related to increase cost in dispensing more than one AB needed (80.1%), although the healing was (63.6 %), delay in response (25%) and complicated wound infection (5%), significant results were arrange nurse error and poor drug availability. In conclusion: medication errors are still common problem in our hospitals, which are mostly related to medical team and the pharmacists should give more effort to avoid these errors.

استخدام المضادات الحیویة في الجراحة یتركز أما في معالجة الأختلاطات البكتیریة المثبتة أو لمنعھا المتوقع بعد العملیة.استخدام المضادات الحیویة بشكل غیر ملائم لعلاج المرضى مع الاختلاطات البكتیریة الشائعة من أھم المشاكل المنتشرة عالمیا", معنتائج كبیرة نسبة إلى كلفة المعالجة وتطور المقاومة إلى العامل ذو المعاداة المیكروبي. علاوة على ذلك, المضادات الحیویة غالبا"ماتصرف بدون دلالة سریریھ واضحة.ھذه الدراسة أجریت لتقییم الأخطاء الطبیة في استخدام المضادات الحیویة لمرضى الجراحة التيقد تؤثر على شفاء جروحھم. 260 مریض من ردھة الجراحة مع جراحة نظیفة- ملوثة وجراحة ملوثة ضمنوا من أثنین من المستشفیات% التعلیمیة, تضمنت الدراسة 160 مریض من مستشفى مدینة الطب و 100 مریض من مستشفى الكاظمیة, 86 % كانوا نساء و 3215 .ھذه الدراسة أظھرت أخطاء طبیة تعود إلى أسباب مختلفة: أولا", خطأ الفریق الطبي الذي -/+ رجال, مدى أعمارھم كان 402) تغییر المضادات الحیویة بدون ,(% تضمن الممرضة ( 70.9 %) والطبیب وتضمن 1) تأخر في متابعة المریض بعد العملیة ( 5.9اختبار الحساسیة والزرع ( 48.8 %), و 3) عدم اكتمال متطلبات الوصفة ( 13.1 %), ثانیا": خطأ طلبي ویتضمن 1) غیاب المصدرالأصلي للمضادات الحیویة ( 44.5 %), و خطأ في توفر المضاد الحیوي المختار ( 74.8 %), ثالثا": خطأ یعود إلى المریض نفسھویتضمن 1) الحالة الاجتماعیة الاقتصادیة ( 14.5 %), الحالة التعلیمیة ( 54.3 %), وأخیرا" خطأ یعود إلى زیادة التكلفة في صرفلأكثر من مضاد حیوي مطلوب ( 80.1 %), لكن الاستجابة للشفاء كان ( 63.6 %), تأخر في الاستجابة ( 25 %) وتلوث جروح معقد%5 ). في الاستنتاج: الأخطاء الطبیة تبقى من المشاكل الشائعة في مستشفیاتنا والتي غالبا" ما تعود إلى أسباب الكادر الطبي والصیادلة )الذین یجب أن یبذلوا جھود أكثر لتجنب ھذه الأخطاء.


Article
PORT SITE INCISIONAL HERNIA AFTER MINIMAL ACCESS SURGERY

Authors: Sadiq Kassim Jassim --- Mazin H AL-Hawaz --- Jasim D Saod
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 2 Pages: 37-44
Publisher: Basrah University جامعة البصرة

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Abstract

Incisional hernia is a common sequel to open abdominal surgery, affecting 5–15% of patients. The introduction of laparoscopic surgery into clinical routine more than 20 years ago has dramatically changed the field of surgery. It is commonly held that the frequency of incisional hernia has been reduced since the introduction of minimal access surgery. The incidence of port site hernia ranges from 1% to 6%. The aim of this study is to identify most common causes of port site incisional hernia. This is a retrospective study of 2116 patients who underwent laparoscopic surgery between January 2006 and December 2010. The information obtained according to indication of surgery, onset of hernia, clinical risk factors for incisional hernia like age& sex, BMI, co-morbidity, and those related to surgical factors such as port site, port size, port site infection and abdominal access techniques. The data were retrieved for patients who developed port-site incisional hernia (PSIH). The incisional hernia rate for the entire series was 2.5%. Most port site hernias developed in the 10 mm port, in the umbilical and supra umbilical, midline and 0% for the off-midline. There was statistically significant difference in patient’s related risk factors regarding age, BMI and wound infection with development of port site hernias. Conclusion: In this series, the 10mm port in midline site is a significantly higher cause for incisional hernia than the off-midline and smallest port size. Open first access technique, obesity and port site infection also significantly increase the incidence of port site incisional hernia.Introductio


Article
Comparison Between Mechanical and Non Mechanical Bowel Preparation Prior To Elective Colorectal Surgery

Author: Wissam Jaffar Altaee وسام جعفر
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 2 Pages: 85-90
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Bowel preparation prior to colonic surgery usually includes antibiotic therapy together with mechanical bowel preparation which may cause discomfort to the patients, prolonged hospitalization and water & electrolyte imbalance. Objective: to assess whether elective colon and rectal surgery may be safely performed without preoperative mechanical bowel preparation. Method: the study includes all patients who had elective large bowel resection at Medical City – Baghdad Teaching Hospital between Feb, 2007 to Jan, 2010. Emergency operations were not included. The patients were randomly assigned to the 2 study groups (with or without mechanical bowel preparation. Results: A total of 165 patients participated in the study, 82 with mechanical bowel preparation and 83 without. The 2 groups were similar in age, sex and type of surgical procedure. 134 patients (81.2 %) underwent surgery owing to colorectal cancer & 31 patients (18.8 %) owing to benign disease. The hospitalization period was longer in the bowel-prepared group (mean ± SD, 8.2 ± 5.1 days) as compared with the non prepared group (mean ± SD, 8.0 ± 2.7 days). However, this difference was not statistically significant. The time until the 1st bowel movement was similar between the 2 groups : a mean ± SD of 4.2 ± 1.3 days in the non prepared group as compared with a men ± SD 4.3 ± 1.1 days in the prepared group ( P = NS ). Conclusion: Our results suggest that no advantage is gained by preoperative mechanical bowel preparation in elective colorectal surgery.


Article
A clinical comparative evaluation between upper and lower first molar apicectomy procedures (A retrospective trial).

Authors: Wafaa K Fathi --- Wael T Al Wattar
Journal: Al-Rafidain Dental Journal مجلة الرافدين لطب الأسنان ISSN: 18121217 Year: 2011 Volume: 11 Issue: 2 Pages: 381-389
Publisher: Mosul University جامعة الموصل

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Abstract

Aims: The aim of this retrospective clinical trial was to evaluate and compare the upper and lower first molar apicectomy procedures in terms based on certain clinical criteria selected. Materials and Meth-ods: This clinical trial was conducted at the Department of Oral and Maxillofacial Surgery / College of Dentistry / University of Mosul. The sample recruited was composed of forty healthy subjects who required apicectomy procedures on either an upper or lower fist molar. The sample was subdivided into two groups of twenty subjects each. The first group comprised those patients where root end resection ( apicectomy ) on an upper first molar tooth was required. The second group included those patients who required an apicectomy procedure on one of their lower first molar tooth . Criteria that were eval-uated and compared included pain, swelling and trismus which were evaluated on the first operative day, second, third and seventh postoperative day. Results: A significant difference was observed be-tween recall visits in regard to the pain level of mandibular procedures and was also observed in maxil-lary procedures. In regard to pain level assessment between mandibular and maxillary procedures, a significant difference was observed with pain levels higher in mandibular procedures for the second and third day when compared to maxillary procedures. A significant difference was observed between recall visits in regard to swelling of soft tissue of mandibular and maxillary procedures. Concerning grade of swelling assessment between mandibular and maxillary procedures, a significant difference was observed with swelling of soft tissue higher in mandibular procedures on the second and third day when compared to maxillary procedures. A significant difference was observed for limitation of mouth opening in mandibular procedures between recall visits specifically on the first and second day but was not observed in maxillary procedures. When comparing between upper and lower surgical procedures, a significant difference was observed in trismus specially on the second and third post-operative day and which was more pronounced in mandibular procedures. Conclusions: It seems that complications following root end resection on lower first molar teeth are more evident when compared to the upper first molar region, but only in the first few days following surgery. However, such complications were tolerable to the patient and can be overcome by medications and exercise. Such complications should not hinder the oral surgeon from performing endodontic surgery on posterior teeth when indicated


Article
Outcome of Endoscopic Sinus Surgery for Antrochoanal polyps
نتائج جراحة الجيوب الأنفية بالمنظار لالاورام الحميدة غازية منعرية

Author: Nada Khalil Yaseen , Rashid Ali Rashid ندى خليل ياسين ، رشيد علي راشد
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2011 Volume: 2 Issue: 172 Pages: 100-108
Publisher: Tikrit University جامعة تكريت

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Abstract

The antrochoanal polyp (ACP) occurs predominantly in children and young adults. In the treatment, since simple avulsion polypectomy is followed by a high recurrence rate, it is therefore common practice to remove the polyp's antral part as well. Endonasal Endoscopic Sinus Surgery has revolutionized in the treatment of sinonasal diseases as it re-establishes ventilation and mucocilliary clearance by limited resection of the inflammatory pathology or the anatomical defects present. The purpose of this study was to evaluate the outcome of endoscopic treatment of ACPs. Between February 2009-January 2011, we enrolled 21 patients with unilateral ACPs (15 left-sided, 6 right-sided). Factors including age, sex, presenting complaints, associated symptoms, physical findings, surgical procedure, histopathology, follow up and management of recurrence were studied .Completely removing the base of the ACPs was achieved through transnasal endoscopic (TE) or combined endoscopic and transcanine (CET) approach. The CET approach was used in recurrent patient. All patients received CT scan 6 months after surgery to evaluate the outcome of surgery. Most of the ACPs were multitudinous and the distributions of the ACPs’ origin in the maxillary sinus were as follows: posterior wall (90%), lateral wall (56.5%), and inferior wall (44.5). The success rate was 76.2 %in the TE approach and 100% in the CET approach. 5 in the TE approach recurred and all of them had concomitant rhinosinusitis. The three patients were cured in the revision CET operations. No major complications occurred. The present study conclude that endoscopic approach as compared to previous modalities of treatment is an effective and efficient method of treating Antrochoanal Polyps Endoscopic treatment of ACPs in children is safe and effective. Early diagnosis and treatment of ACPs is important because secondary rhinosinusitis can make the disease complicated and the surgeries difficult.

وسليلة غازية منعرية (ACP) ويحدث في الغالب في الأطفال وصغار البالغين. في العلاج، ومنذ ويتبع بسيط استئصال السليلة قلع بنسبة تكرار عالية، وبالتالي فمن الممارسات الشائعة لإزالة جزء من الورم وغاري كذلك. جراحة الجيوب الأنفية بالمنظار داخل الأنف قد أحدثت ثورة في علاج الأمراض sinonasal حيث اعادة انشاء والتهوية، وإزالة mucocilliary بواسطة استئصال محدودة من أمراض التهابات أو عيوب تشريحية الحالي. وكان الغرض من هذه الدراسة لتقييم نتائج العلاج بالمنظار من دالات تلويث قطبية شمالية. بين فبراير 2009 كانون الثاني 2011، التحق نحن 21 مريضا مع دالات تلويث قطبية شمالية من جانب واحد (15 في الجانب الايسر (6)، في الجانب الأيمن). وتمت دراسة العوامل بما في ذلك العمر والجنس وتقديم الشكاوى، والأعراض المصاحبة، والنتائج المادية وإجراء العمليات الجراحية، التشريح، ومتابعة وإدارة تكرار. تماما إزالة قاعدة دالات تلويث قطبية شمالية تم تحقيقه من خلال transnasal بالمنظار (TE) أو الجمع بين التنظير وtranscanine (CET) النهج. وقد استخدم هذا النهج في CET المريض المتكررة. وتلقى جميع المرضى الاشعة المقطعية 6 أشهر بعد خضوعه لجراحة لتقييم نتائج الجراحة. وكان معظم دالات تلويث قطبية شمالية الكثيرة وتوزيع أصل دالات تلويث قطبية شمالية "في الجيب الفكي وكانت على النحو التالي: الجدار الخلفي (90٪)، والجدار الجانبي (56.5٪)، والجدار السفلي (44.5). وكانت نسبة النجاح 76.2٪ في نهج الشركة المصرية للاتصالات، و 100٪ في نهج CET. تكررت 5 في نهج الشركة المصرية للاتصالات وجميع من لهم كان يصاحب ذلك التهاب الأنف و الجيوب. وقد شفي المرضى الثلاثة في عمليات CET مراجعة. وقعت أي تعقيدات كبيرة. هذه الدراسة نستنتج أن نهج بالمنظار بالمقارنة مع الطرائق السابقة من العلاج هو وسيلة فعالة وفعالة لعلاج الاورام الحميدة غازية منعرية علاج بالمنظار من دالات تلويث قطبية شمالية في الأطفال هي آمنة وفعالة. التشخيص المبكر والعلاج من دالات تلويث قطبية شمالية أمر مهم لأن التهاب الأنف و الجيوب الثانوية يمكن أن تجعل من مرض معقد والعمليات الجراحية الصعبة.


Article
Efficacy of Paracetamol versus Celebrex on the Control of Post Operative Complications of Lower Third Molars

Author: Maha T Al-Saffar
Journal: Al-Rafidain Dental Journal مجلة الرافدين لطب الأسنان ISSN: 18121217 Year: 2011 Volume: 11 Issue: 1 Pages: 24-31
Publisher: Mosul University جامعة الموصل

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Abstract

Aims: To compare the efficacy of celebrex 400 mg orally one time daily with paracatamol 1000 mg orally four times daily on reducing post operative oral complication (facial swelling, trismus and pain) after third molar surgery. Materials and Methods: A total of 45 patients (24 females, 21 males) with impacted lower third molars divided into two groups; Group I: Twenty patients treated with paracetamol 1000 mg orally four times daily. Group II: Twenty five patients treated with celebrex 400 mg orally one time daily. Results: The mean age of patients was (29.17 ± 5.0) in group I and (27.1± 4.9) in group II with no significant differences, with a higher percentage of mesioangular impaction 40% among other type of impaction in two groups. Patients in group II suffer from less facial swelling and trismus with a significant differences p ≤ 0.05 compared with group I, but the two groups showed no significant differ-ences in related to pain (p> 0.05) after third molar's surgical removal. Conclusions: Celebrex is more effective than paracetamol with less frequency of administration and longer duration of action in reduc-ing post operative oral complication (swelling and trismus), but with some analgesic effect after surgical removal of lower third molars


Article
Changing the Human Sex and the Attitude of Islamic law
تغيير الجنس البشري وموقف الشريعة الإسلامية منه

Author: hatem ahmed abaas حاتم احمد عباس
Journal: Journal of Research Diyala humanity مجلة ديالى للبحوث الانسانية ISSN: 1998104x Year: 2011 Issue: 52 Pages: 166-220
Publisher: Diyala University جامعة ديالى

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Abstract

This study is considered one of the incidents jurisprudence ( Fiqh ) and one of the contemporary issues which are unknown by the old jurists .Section one deals with changing the sex from male female and vice-versa by surgical operation with their and desire .All jurists are unanimous and agree to prohibit any sort of this change because such a change is unjust fable and it is a change of Allah's creation . more over . then are no considerable in motives this change . Such on operation implies fraud and cheating which are rejected and forbidden in Islam .Section Two is concerned whit the sex correction which is relevant to the bisexual the hermaphrodite the bisexual is the one who has the male and female sexual organs or the one who has no male or female organs . They are of two types :The indicated and the unindicated ones the first : the indicated bisexual is the one whose sexual organs have evident indications . it is either male with female feature of the other sex vice-versa . This case is what the physicians call hermaphrodite false whose sexual gland is either the ovary or the testis that cannot be assembled together the apparent organs are vague in . such a case sexual organ to the body . The second type is the unindicated bisexual whose male or female sexual organs are very difficult to identify . This type is what the physicians call the real bisexual what sexual organs are annexed together and can be identified by clinical investigation . These agree with the opinions of the Islamic jurists concerning the emotional and psychological tendencies towered a certain sex .So far the treatment by surgical operations were unavailable , but today it has become possible to identify the type of the sex accessiny to the reality of the male or female particularly in the second type . in such a cases , it is permitted for life and hereafter interests since the Islamic law has come for the interests of human being based on facilitating the legislation on the behalf at mankind .

هذا البحث من فقه النوازل ومن المسائل العصرية والتي استجدت ولم يكن متعارفاً عليها عند الفقهاء القدامى ، تضمن البحث مقدمة ومبحثين وخاتمة واستنتاجات .المبحث الأول : تحدث عن حقيقة تغيير الجنس وذلك عن طريق العملية الجراحية بتحويله من الذكورية إلى الأنوثوية أو العكس ، وهذا يكون مجرد رغبةٍ وهوىً ، مما اقتضى الفقهاء المعاصرين أن يُجْمِعُوا بالقول على حرمته ، لأنه تعدٍّ على الخِلْقةِ التي منحها الله تعالى للإنسان ولم يوجد مُبَرِّر لهذا التغيير ، وليست هناك دوافع معتبرة له ، إضافةً إلى أنّ عملية تغيير الجنس تتضمن الغش والتدليس وكل ذلك حرام ترفضه الشريعة الإسلامية .وتضمن المبحث الثاني : تصحيح الجنس – وهذا يتعلق بـ ( الخنثى ) وهو الذي يطلق عليه الفقهاء بأنه : مَنْ له آلة الرجال والنساء ، أو هو مَنْ له ذكر وفرج امرأة، أو هو مَنْ لا يكون له ذكر ولا فرج أصلاً ، وهو نوعان : الخنثى غير المُشْكِل ، والخنثى المُشْكِل .الأول : الخنثى غير المُشْكِل : هو مَنْ اتضحت فيه العلامات الدالّة على ذكوريته أو انوثيته ، فهو أما رجل أو امرأة فيهما خلقةً زائدة ، وهذا ما يطلق عليه الأطباء : ( الخنثى الكاذبة ) وهي ما كانت غدتها التناسلية احدى اثنتين : المبيض أو الخصية ، ولا يمكن اجتماعهما سويةً ، والأعضاء الظاهرة فيها تكون غامضة ، فيمكن تشخيص جنسه وتحديده وأجراء عملية تصحيحه ، وهذا جائز شرعاً لأنه ليس تغييراً ولا تحويلاً ولا تدخل فيه عملية الرغبة والهوى . وإنما مقصوده إعادة عضو الجسم إلى الخلقة المعهودة السوية . الثانية الخنثى المُشْكِل : وهو الذي تعذر الوصول إلى المعرفة الحقيقية من جنسه الذكري أو الانثوي ويطلق عليه الأطباء : ( الخنثى الحقيقية ) وهي من اجتمع فيها العضوان المبيض والخصية معاً ، وقد يكونان مُلتحمَين سوياً ، ويكون تحديد ذلك بالفحص والتشخيص ، أو هي متفقة مع كلام الفقهاء من حيث الميول النفسية والعاطفية نحو جنس معين .وعلاجه لم يكن مطروقاً عندهم ولا متيسراً في عصرهم لذا فعلاجه عن طريق العمليات الجراحية أصبح وليد هذا العصر . يُتوَصَّلُ من خلالها إلى معرفة تحديد الجنس والوصول إلى حقيقته الذكورية أو الأنوثوية قدر الإمكان خصوصاً في الخنثى الحقيقية – الخنثى المشكل – وهذا جائزٌ شرعاً ، لأن فيه من المصالح الدينية والدنيوية ما لا يكون خافياً ، والشريعة جاءت لمصالح الأنام وبنت أحكامها اليسر والسهولة في التشريع .

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