Sepsis is a very common condition in emergency hospitals and presentation is variable, it is under diagnosed with very high mortality rate. All patients with infection are at risk of developing sepsis. Sepsis is a complex condition characterized by activation of inflammatory process and coagulation system in response to microbial insult. An observational prospective study was carried out at RozhHalat emergency hospital in Erbil-Kurdistan region of Iraq between February 2017 to January 2018.The study was approved by the scientific and ethical committee of Kurdistan board of medical specialties. 50 patients aged between (10 - 80) years old presented to this hospital with sign and symptoms of infection were recruited to this study. 50 patients with signs and symptoms of sepsis were recorded in this study. The mean age was 47 with male to female ration of 2:3 (42% male and 58% female). The overall mortality rate was high at 68% with higher rate among female and older age group. The blood culture was positive in 74% of cases of which 52% were gram positive and 22% were gram-negative microorganisms. A Positive blood culture associated with higher mortality rate of 81% compared with 21% if the blood culture was negative. In majority of cases the site of infection was from multiple source (34%) followed by respiratory infection (26%).Skin and soft tissue infection was associated with the lowest mortality of 2.9%. High number of cases (82%) developed complications and 52% of cases developed more than 2 organ failures. All patients received empirical antibiotic therapy however 46% of cases received the wrong antimicrobials. The survival rate was higher (44%) among patients given the right antibiotics. Similarly patients had better chance of survival if appropriate fluid resuscitation therapy was give. The overall mortality among vasopressor treated patients were 72% compared with 78% chance of mortality if they were not treated with any vasopressor therapy, among those who received inotropic support Noradrenaline associated with higher survival rate(72%). A qSOFA score of more than 2 associated with 86.4 % of mortality compared with 75.5% mortality with similar SIRS criteria. Factors associated with high mortality were: female gender, older age group, positive blood culture, wrong antibiotics therapy, less fluid resuscitation, multisource of infection, multi-organ failure, high lactic acid level and high qSOFA score. This study shows that sepsis is associated with high overall mortality rate of 68% in the RozhHalat emergency hospital and higher rate of death among female and older age group. Negative blood culture, appropriate use of antibiotics and fluid therapy associated with better chance of survival. Vasopressor therapy did not result in better survival outcome except for Noradrenaline. The qSOFA score is as good as SIRS criteria in predicting mortality. High lactate, multi-organ failure and multisource of infection associated with the worst outcome.
Breast cancer is the global health problem. It is the highest prevalent site-specific cancer in women throughout the world and the most common reason of death in middle age women, following lung cancer. Up to 5% of breast cancers are caused by inheritance. Male breast cancer accounts for less than 1%. Mammography is the first imaging study to evaluate breast abnormalities, Ultrasound is particularly useful in young women with dense breasts. Core needle biopsy permits the analysis of breast tissue architecture and whether invasive cancer is present. To compare core needle biopsy and imaging, the accuracy of each modality for purpose of the diagnosis and their impact on preoperative planning before surgical treatment. A retrospective cohort study was performed in 70 cases of breast cancer during 2015-2017 at Slemani Breast Center/ Kurdistan region. Inclusion criteria any patient with diagnosed with breast cancer for whom core biopsy and imaging techniques (ultrasound and mammography) were done, Age 25 years and above. Exclusion criteria, a patient with breast mass who did not underwent: one of the two modalities, Age below 25 years, pregnant women. In the current study: mean age/year for the participants were Mean age = 51.34 year ± 12.85 SD), Sixty-nine cases were female and one male. By core biopsy (97.1%) is positive for malignancy. In this study: results about 34.28% of BIRADS V (ultrasound)lesions proved to be positive for malignancy by core biopsy, 1.43% of BIRADS V were negative for malignancy and the association was statistically highly significant, for BIRADS III lesions 17.14% were proved as positive for malignancy by core biopsy. About 45.7% of BIRADS V (mammography were positive for malignancy by core biopsy and the associations were found to be statistically highly significant and for BIRADS III 12.85% of lesions were positive for malignancy by core biopsy. There was a statistically significant association between radiological investigation(ultrasound, mammography) and histopathological finding (core biopsy).
This is a multi-center retrospective study of patients underwent low anterior resection for rectal cancer. Ileostomy had been done to protect low lying Colo-rectal anastomosis, closure of ileostomy had been delayed in some patients due to patient own will, surgical complications (anastomotic leak) or coarse of chemotherapy. This study aimed to find the effect of temporary ileostomy on post-operative bowel defunction which is called Low anterior resection syndrome (LARS), and include; urgency, difficulty in emptying of bowel, and incontinence for feces and flatus. A total of 50 patients included in this study, the age ranges from the 19 to 80 years old with a mean age of 51.96 years. The total number of males was (33, %66). Majority of patients were overweight (21, 42%). The distance of tumors from the anal verge were less than 10 cm in (31,62%). The mean duration of fecal diversion was 7.17 months. Loop ileostomy were closed before six months in (27,54%). The mean duration of diversion of patients developed no LARS was 6.87 months which is shorter than those of developed LARS (7.31). Lower BMI patients are more prone to develop LARS, while Obese patients are more susceptible to develop major LARS. Nineteen cases developed LARS among those patient’s ileostomy closed before six months, and 15 cases developed LARS in those ileostomies closed after six months.
Acute abdominal pain is a frequent symptom to the emergency department, can be caused by various pathologic processes. The aim of this study was to appraise the role of serum amylase level in diagnostic workup of non-traumatic adult patients presented with acute abdominal pain to surgical emergency department (ED). Our study is based on data collected retrospectively from patients' medical records admitted to Shar Emergency Surgical Unit, Sulaimani, Iraq from 10 th January 2019 to 20 th May 2019. All non-traumatic adult patients with acute abdominal pain within twenty-four hours before admission were included and serum amylase levels were measured on admission using Enzyme-Linked Immunosorbent Assay (ELISA) available at (ED). Overall, 68 patients were included, with mean age of 45.9 years over the aforementioned time period, 44 females (64.7%) and 24 males (35.3%), of which 37 patients had normal serum amylase level (14 male and 23 female patients), defined as levels between (35 IU/L-115 IU/L) by the laboratory (ELISA) device used for all the tests, while the other 31 patients (10 males and 21 females) had high serum amylase levels due to different disease processes, the most common two with equal frequencies were acute calculous cholecystitis (41.9%) and acute pancreatitis (41.9%). Elevated serum amylase levels can be observed with several medical and surgical problems in patients with
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