From
the Editor
In this issue of the journal
there are a number of papers from the Region
dealing with various topics including surgical
and medical.
Azar BH. et al., reported and compared early
experience of surgery and endovascular ablation
combined with sclerotherapy. They followed a
retrospective multicenter cohort study included
patients diagnosed as cases of primary lower
limb varicosities. The study included 71 patients,
with mean age of 36.26. The most common finding
was bilateral affection (27, 38%). Forty patients
(56.3%) underwent surgical intervention and
other 31 (43.7%) had endolasar ablation and
sclerotherapy. Although early complications
occurred more with the surgical intervention,
the difference was not reached statistical significance.
Over all, the late complications were not significantly
different in both arms of interventions. Both
(late and early complications) were highly significantly
related to the severity of the CEAP classifications
(both p-values were less than 0.001). The authors
concluded that endolaser ablation with sclerotherapy
is starting in Iraq. Although it is in the early
stage of its development, it has better outcome
compared to the classical surgical intervention.
Younis SN, et al.; carried a study to evaluate
the relationship between apparent diffusion
coefficient (ADC) values of renal parenchyma
and different stages of chronic kidney disease
and compare it with serum creatinine and estimated
GFR among patients who referred to Rizgary Teaching
Hospital in Erbil. An analytic cross-sectional
study that was carried out from November 2017
to April 2018. In so doing, 12 individuals (control
group) and 38 patients (patient group) diagnosed
with known chronic kidney disease (CKD) were
selected. After they had undergone magnetic
resonance imaging of the upper abdomen, the
patient group subjects were classified in different
stages of CKD based on estimated glomerular
filtration rate (eGFR) calculated using chronic
kidney disease epidemiology (CKD-EPI) equation.
The results of the present study revealed a
significant inverse correlation between ADC
values and serum creatinine in the patient group.
Also, there was a strong positive correlation
between ADC and eGFR in the patients with CKD.
Moreover, the patient group had a significantly
lower mean ADC compared to the control group.
The authors concluded that the observed correlation
between ADC values and serum creatinine and
eGFR in the patients under investigation in
the present study indicated that the presence
and degree of renal dysfunction can be determined
through ADC values.
Rashid SA. et al., investigated the capacity
of diffusion-weighted magnetic resonance imaging
(DW-MRI) in differentiating hepatic hydatid
and simple cysts among patients. According to
the results of DW-MRI (b=0, 400, and 800), most
of the cysts were hyperintense. Moreover, the
results of comparing mean DW cyst at b0, b400,
and b800 among types of hepatic cysts showed
that CE2 and CE4 had the highest prevalence.
Also, comparing mean DW cyst to parenchyma ratio
at b0, b400, and b800 among types of hepatic
cysts revealed that the highest prevalence belonged
to CE3 and CE4. Moreover, comparison of mean
ADC cyst at b0 and b800 among types of hepatic
cysts showed the highest prevalence for CE3
and CL. Finally, comparing mean ADC cyst to
parenchyma ratio at b0 and b800 among types
of hepatic cysts revealed the highest prevalence
for CL and SHC. The authors concluded that DW-MRI
may have the capacity to differentiate between
hepatic hydatid and simple cysts.
Mehmet Rami Helvaci, MR et al., looked at the
effect smoking on weight. Smoking may cause
loss of appetite via endothelial inflammation
all over the body. Consecutive patients with
coronary artery disease (CAD) were studied.
Study included 2860 cases (1620 females),. Prevalence
of CAD were similar in females and males (3.8%
versus 4.4%, respectively, p>0.05) with mean
ages of 61.5 versus 63.5 years, respectively
(p>0.05). Smoking and chronic obstructive
pulmonary disease (COPD) were significantly
higher in males with CAD (54.5% versus 9.6%,
p<0.001 and 18.1% versus 6.4%, p<0.05,
respectively). Whereas low density lipoprotein
cholesterol (LDL-C) (132.6 versus 115.6 mg/dL,
p= 0.008), triglyceride (TG) (250.3 versus 150.1
mg/dL, p= 0.002). The authors concluded that
smoking and excess weight may be the major underlying
causes of metabolic syndrome in Turkey, and
they may cause similar degree of clinical severity.
Mehmet Rami Helvaci, MR et al., tried to understand
whether or not there is a significant relationship
in between urolithiasis and smoking. Consecutive
patients with urolithiasis were collected into
the first, and age and sex-matched controls
were collected into the second groups Fifty-one
patients with urolithiasis and 66 controls were
studied, totally. When we looked at the urolithiasis
patients, 56.8% of them (29 patients) were female
with a mean age of 47.2 ± 12.7 (22-70)
years. Interestingly, although the lower prevalence
of smoking in females in population, the prevalence
of smoking was significantly higher in the urolithiasis
group, here (45.0% versus 30.3%, p<0.05).
the authors concluded that Several toxic substances
found in cigarette smoke get into the circulation
by means of the respiratory tract, and cause
a low-grade vascular endothelial inflammation
all over the body including the gastrointestinal
and urinary tracts. The low-grade vascular endothelial
inflammation eventually terminates with an accelerated
atherosclerosis and relative immunosuppression.
The prolonged vascular endothelial inflammation,
accelerated atherosclerosis, relative immunosuppression,
and sympathetic nervous system activation may
induce motility, absorption, and infectious
problems in the gastrointestinal and urinary
tracts those may terminate with urolithiasis
in smokers.
In our Education and Training section, Maurice
Brygel, General Surgeon, provides an update
and overview of the treatment of haemorrhoids,
including rubber band ligation. This will be
useful to family doctors undertaking day surgery
in the office and for medical and surgical students.
Chief Editor:
A. Abyad
MD, MPH, AGSF, AFCHSE
Email: aabyad@cyberia.net.lb
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