Ahmed Hussein

Background: Peptic ulcer disease’s second-most common complication is perforation, constituting a surgical emergency with approximately 30% short-term mortality and 50% morbidity. Patients with untreated duodenal ulceration face a 10% lifetime risk of perforation, reduced with initial ulcer healing. The Graham omental patch technique involvesleaving two tube drains, one in Morrison’s pouch and one in the pelvis. This study aims to elucidate the effects of routine abdominal drain use on postoperative outcomes after closure surgery for peptic ulcer perforation, assessing the efficacy and safety of this approach.Methods: A prospective observational cross-sectional study enrolled 60 patients conducted between December 2021 and January 2023, with perforated peptic ulcers who underwent repair using the Graham omental patch technique. Two tube drains were utilized. Postoperative follow-up and complication observation involved categorizing patients into two groups (A and B) based on the presence or absence of drain-related complications.Results: Drain-related complications were seen in 40% of study subjects, most common of which was Drain site pain followed by Restriction of mobility and Peri tubal discharge/leakage with skin excoriation. Late presentation (>24 hours), Gastric ulceration, perforations larger than 1 cm and peritoneal spillage of more than 1000 ml significantly influencedthe outcome and rate of development of post operative drain related complications in patients operated for perforation peptic ulcer.Conclusion: All drains carry a risk of significant postoperative complications. In the setting of good surgical technique and the presence of sufficient equipment for the detection of intra-abdominal complications postoperatively like ultrasonography and CT scan, abdominal drains should be used rationally.

Background: Total thyroidectomy is the most common endocrine surgery performed in hospitals worldwide. Thyroidgland is a highly vascularized structure and has a rich supply therefore; delicate techniques must be used in its excision.Classical techniques have been used for decades with adequate outcomes but have been associated with numerous dismalcomplications. The use of harmonic scalpel in thyroid surgery made a breakthrough by decreasing these complications.This study aims to compare two techniques (Harmonic scalpel vs. Classical techniques) by measuring the differences induration of operative time, amount of blood loss, and other inadvertent complications.Methods: This is a prospective observational cross-sectional study in which 80 patients were included and operatedon at Azadi Teaching Hospital, Kirkuk, Iraq. They were divided into two equal groups, group harmonic scalpel (40patients) that had total thyroidectomy by harmonic scalpel and group classical techniques (40 patients) that had totalthyroidectomy by classical techniques by means of electrocautery and knot-tying.Results: Harmonic scalpel group showed a significant reduction in operative time (p value = 0.004), amount of intra-operative blood loss (p value <0.001), postoperative fluid drainage (p value <0.001) while there were no significantdifferences between the two groups in risk of laryngeal nerve injury or length of hospital stay.Conclusion: Focused harmonic scalpel was an effective and reliable technique in performing safe total thyroidectomiesand had the advantages over other classical techniques in reducing the operative time, amount of intra-operative bloodloss, postoperative fluid drainage with parallel other postoperative complications.

© 2015 American Urological Association Education and Research, Inc. Purpose: We describe the outcomes of patients with low risk localized prostate cancer who were upgraded on a surveillance biopsy while on active surveillance and evaluated whether delayed treatment was associated with adverse outcome. Materials and Methods: We included men in the study with lower risk disease managed initially with active surveillance and upgraded to Gleason score 3+4 or greater. Patient demographics and disease characteristics were compared. Kaplan-Meier curve was used to estimate the treatment-free probability stratified by initial upgrade, Cox regression analysis was used to examine factors associated with treatment and multivariate logistic regression analysis was used to evaluate the factors associated with adverse outcome at surgery. Results: The final cohort comprised 219 men, with 150 upgraded to 3+4and 69 to 4+3 or greater. Median time to upgrade was 23 months. A total of 163 men sought treatment, the majority with radical prostatectomy. The treatment-free survival rate at 5 years was 22% for 3+4 and 10% for 4+3 or greater upgrade. Upgrade to 4+3 or greater, higher prostate specific antigen density at diagnosis and shorter time to initial upgrade were associated with treatment. At surgical pathology 34% of cancers were downgraded while 6% were upgraded. Cancer volume at initial upgrade was associated with adverse pathological outcome at surgery. Conclusions: After Gleason score upgrade most patients elected treatment with radical prostatectomy. Among men who deferred definitive intervention, few experienced additional upgrading. At radical prostatectomy only 6% of cases were upgraded further and only tumor volume at initial upgrade was significantly associated with adverse pathological outcome.

The Holy Qur'an and the Sunnah of the Prophet are a rich source of learning about human psychology and the personality types, patterns and traits. This study attempted to understand whether personality types and patterns can be understood through Islamic knowledge. For this purpose, the study examined the personality traits as laid down in the Qur’an and later disseminated though the hadiths. A qualitative research design was adopted for this study, combining philosophical and phenomenological approaches, where the former captured the religious essence of the personality types, patterns and traits, and the latter revealed their significance from the Islamic perspective. The primary data was collected from religious scriptures, hadiths, and the Qur’anic verses, while the secondary data sources included books, articles and critical commentaries on the hadiths and religious scriptures. The data was analyzed through a theoretical and analytical framework, using classification methods, and focusing on both methodological as well as descriptive aspects of personality types, patterns and traits in the light of the Holy Qur’an. The findings revealed the in-depth presence of advice and wisdom about personality traits in the Holy Qur’an. The study reiterated that the human race is only capable of knowing the true existence of God Almighty owing to its intrinsic human characteristics, and being an integrated entity of mind, body, and soul. The implications of the study leis in its re-establishing the concept of faith through intellectual and practical applications.