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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