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(6 – 24) Months in Erbil City Estimation of Hemoglobin Level in ApparentlyHealthyChildren between (6 – 24) Months in Erbil City Name: Ahmed A. Ahmed Degree: Higher Diploma Specialty: Pediatrics Date the debate: 20/10/2008 Supervisor: Asst Prof. Abbas A. Al-Rabaty Abstract Background: Anemia is still one of the most common problems in the world even in developed countries, but its evaluation is still underestimated like an ice-berg especially in developing countries like us, so it needs further planning, screening and management. Setting: This study was done in 12 primary health care centers PHCC in Erbil city – Kurdistan region/Iraq. During period of 1st Feb - 30th July 2008. Objectives: The main objectives were to determine the Hb value in our children, to estimate the prevalence of anemia and correlating with factors that may be associated with low Hb level. Subjects and methods: This prospective study was conducted in 500 apparently healthy children collected randomly, visiting the vaccination centers routinely during 5 months period. A closed-ended questionnaire was administered in each child to obtain data which included personal history, feeding pattern, physical examination and Hb reading which was performed at the same time, using Sahli method. Results: From total 500 children conducted in this study, the mean Hb was 10.4 g/dl. Those with normal Hb were 196 (39.2%), while 304 (60.4%) of them were anemic, those with mild anemia were 145 (29.0%) and 159 (31.8%) of them with moderate anemia. Children with breast feeding had lower percent of anemia ( 26.1% ), while those with whole cow‟s powder milk ( 82.0% ) of them were anemic anemia was most common in low socioeconomic, crowded families, mothers with low educational levels, delayed mile stone, diluted bottle feeding and whole cow‟s milk feeding infants and children. Conclusions: There is high prevalence of anemia among the children conducted in this study and there are many wrong feeding patterns among the mothers that are strongly related to the anemia, like diluted bottle feeding or whole cow‟s milk, while anemia was less common in children with breast feeding. Anemia had strong relation to the educational level of the parents, family size and socioeconomic status of the families. Randomized, Prospective Comparison of Post-Operative Pain in Low-Versus Standard-Pressure Pneumoperitoneum In laparoscopic Cholecystectomy Name: Nabaz Hasan Ismaeel Degree: Higher Diploma Specialty: General Surgery Date the debate: 4/12/2008 Supervisor: Dr. Ali A. Al-Dabbagh Abstract Background: Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholelithiasis, compared with traditional open cholecystectomy (OC), it has improved surgical outcome in terms of reduced pain, morbidity, and duration of convalescence. Although (LC) results in less pain than (OC), it is not a pain-free procedure. Reduced postoperative pain after (LC) may be able to be further optimized. Carbon dioxide insuflation constitutes the commonest means of creating the pneumoperitoneum, but it is attributed to many post-LC effects on the cardiovascular and pulmonary systems and the kidneys, it also causes stretching of the peritoneum and the diaphragm causing irritation of nerve endings & triggers pain. Objectives: The aim of this randomized clinical trial was to evaluate the efficacy of low-pressure carbon dioxide pneumoperitoneum during (LC) in reducing the incidence of postoperative pain. Methods: A double-blind, randomized, clinical trial was conducted on 100 patients with symptomatic gall stones. Patients were randomized preoperatively into Low-pressure (group A) and Standard-pressure (group B) carbon dioxide pneumoperitoneum. Patients in group A (n=50) underwent (LC) with 8 mmHg carbon dioxide pneumoperitoneum throughout the procedure and those in group B (n=50) had (LC) with 12 mmHg carbon dioxide pneumoperitoneum. Abdominal and shoulder-tip pain were assessed with verbal rating scale (VRS) scoring at 4, 8, 12 and 24 hours postoperatively. Results: The low-pressure pneumoperitoneum did not increase the duration of surgery. There were neither significant intra-operative or postoperative complications nor conversion to open procedure in either group. A statistical comparison of mean cumulative Verbal Rating Scale scores for abdominal and shoulder-tip pain in both groups shows statistical significance at 4, 8, 12 and 24 hours after operation. Conclusion: A carbon dioxide pneumoperitoneum at 8 mmHg reduces both the frequency and intensity of abdominal and shoulder-tip pain following LC without increasing the risks on intraoperative complications. Evolution of Ureteroscopy in Urology Department / Rezgary Teaching Hospital Name: Hiwa Esmaeel Mohammed Degree: Higher Diploma Specialty: Urology Date the debate: 8/10/2008 Supervisor: Asst Prof. Pishtewan Hashim Al-Bazzaz Abstract Purpose: The aim in this study is to evaluate a modern ureteroscopy series including, operative techniques, indications for ureteroscopy and postoperative complications. Patients and Methods: From Jun 2007 to March 2008, 99 patients were reviewed who underwent 102 ureteroscopic procedures at Urology Department / Rezgary Teaching Hospital. Results: We had used semirigid ureteroscope to perform ureteroscopy in 99 patients; 55 males and 44 females. The most common indication for ureteroscopy was ureteric stone 79 patients. Diagnostic ureteroscopy performed in 20 cases, 4 of them had no finding and 16 patients had a ureteral stenosis or stricture. The total stone free rate was 81.48%, distal stone free rate was 78.8% and proximal stone free rate was 16.6%. JJ stents were used in 27 patients (27.3%). Regarding frequency of complications we had 9.1% ureteral perforations and 20.2% ureteral false passages. Conclusion: According to our experience, ureteroscopy is a reasonably safe and a feasible option for the treatment of ureteral calculi and other ureteral diseases, when used by experienced hands and even when complications (perforation, false passage and bleeding) occur they can be treated easily by inserting a double J stent in the ureter. Cryotherapy of 2 Weeks versus 3 Week Interval for Common Warts Name: Shadan Hassan Mohammed Degree: Higher Diploma Specialty: Dermatology and Venerology Date the debate: 8/10/2009 Supervisor: Dr. Intiha Mohammed Almosuly Abstract Cryotherapy with liquid nitrogen is a widely used method of treatment for common warts by dermatologists. Traditionally, when treating warts, liquid nitrogen is applied at intervals of 3 weeks. This study was designed to compare the efficacy, and time to clearance of 2-weekly and 3-weekly interval cryotherapy of patients attending the department of dermatology and venereology at Rizgary Teaching Hospital in Erbil City. In this comparison study 80 immunocompetant patients age range, 10-55 years with common warts on the hands and/or feet were enrolled from November 2008 through May 2009. Patients were randomized to receive cryotherapy at interval of either 2 or 3 weeks. All patients allocated to have liquid nitrogen applied with a cryo-spray technique. Cure rates were evaluated in both groups after 3 months and after 6 treatments. Seventy-two patients completed the study. The mean times to clearance of all warts in both group were 9 weeks in 2-weekly and 14 weeks in 3-weekly group (P<0.05). The mean numbers of treatment sessions required to achieve clearance were similar in each group (4.5 and 4.7 treatment sessions) for 2- and 3- weekly groups respectively (P>0.05). Cure rates at 3 months were 64% in the 2-weekly interval treatment group and 45% in the 3-weekly group (P<0.05). After 6 treatment sessions cure rates were similar for both groups; 65% and 60% for 2- and 3- weekly groups respectively (P>0.05). Morbidity was slightly greater in the 2-weekly interval treatment group (P>0.05). This study concluded that, cryotherapy of common warts is effective and the percentage of cure is related to the number of treatments received, and independent of the interval between treatments. A more rapid cure may, therefore, be achieved by more frequent treatment. Above and Below-the-Elbow Plaster Casts for Distal Forearm Fractures in Children Name: Reemon Lazar Sliwa Degree: Higher Diploma Specialty: orthopedic surgery Date the debate: 24/11/2009 Supervisor: Asst prof. Abdul-Wahab Al-Mmukhtar Abstract Closed fractures of the distal third of the forearm are the most common fractures of childhood, but the method of immobilization after closed reduction is controversial. This study was undertaken to determine whether below elbow casts are as effective as above elbow casts in immobilizing these types of fractures and to identify patient and treatment considerations that are related to loss of reduction. Methods: We designed a blinded, randomized, controlled trial. The criteria for reduction and remanipulation were set a priori. The primary outcome measure was fracture immobilization as reflected by reangulation in the cast and by the need for remanipulation. Results: A total of 90 children were enrolled in the study and were allocated to two groups: the above elbow cast group (forty nine children) and the below elbow cast group (forty-one children). The mean age was 9.34 years, and eighty patients were boys. The groups did not differ with respect to the initial fracture angulation, post-reduction angulation, reangulation during cast immobilization, and angulation of the fracture at the time of cast removal. In the above elbow cast group, twenty one (42%) of the 49 children in the above elbow cast group met the criteria for remanipulation compared with thirteen (31.7%) of the forty one children in the below elbow cast group (p = 0.27). the thirty four children who met the requirements for remanipulation, only four (three in the above elbow cast group and one in the below elbow cast group) actually underwent remanipulation. Children with fractures of both the radius and ulna (p = 0.01) and those with residual angulation after reduction (p = 0.0001) were at the highest risk of meeting the criteria for remanipulation. The rates of complications related to the cast did not differ between the groups.
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