Background: Laparoscopic cholecystectomy has many difficulties which include port Insertion, Dissectionof the Calot’s Triangle , Grasping of the Gallbladder , Wall thickness, Adhesion and extraction of theGallbladder. Aim of the Study: To predict how difficult cholecystectomy will be from assessing the patientpreoperatively which, in turn, help in decreasing the risks on the patients and preventing post-operativecomplications. Patients and Methods: A prospective study conducted in the department of General Surgeryat Al-Ramadi Teaching Hospital for the period of nine months from 15th of May 2018 till the 15th of February2019. It included 60 patients, all of them were undergone laparoscopic cholecystectomy for Gallstone. Patientswith common bile duct calculus, dilated common bile duct, current attack of acute cholecystitis, those withabsolute contraindications to laparoscopic cholecystectomy, The data were collected prospectively to predictthe significance of association with patients’ characteristics. The time of operation was calculated from thefirst port site incision until the last port closure. All the intra operative events were recorded. Conversionsto open cholecystectomy were done by median or subcostal laparotomy according to the surgeon’s decisionand each patient’s condition. Results: In this study, the highest proportion of operations was categorizedas easy (58.3%), 28.3% of operations were considered difficult and 13.3% of them were very difficult. Asignificant association (P < 0.05) between operation difficulty and all of the following characteristics: Aging,obesity, history of previous biliary hospitalization, thickened bladder wall, pericholecystic collection, andlarge stones. Conclusions: The difficult laparoscopic cholecystectomy can be predicted preoperativelybased on number of factors, like: obesity, previous biliary admission, gall bladder wall thickness, ultrasoundfindings (stone size and pericholecystic fluid) and aging process, evaluating of such factors minimize thecomplications of laparoscopic cholecystectomy and conversion to the open procedure.
After 2003, Iraq witnessed new challenges represented by the predominance of sectarian discourses, hatred and extremism at the expense of moderate political discourse and the predominance of sub-affiliations and external agendas at the expense of national affiliation, which led to the creation of an unsafe or stable environment dominated by the character of violence and terrorism. Moderate discourse would work to fuse sub-affiliations into one melting pot in which it would be the first loyalty to the homeland and not to the tribe, party or sect... Etc., and this in turn will contribute to promoting peaceful coexistence between the various other sub-affiliations within the framework of one community construction
Besides the role of state institutions that come in the forefront of their priorities and obligations to provide security and development of the economy and reduce the unemployment rate and the reduction of inflation and improving education, health and others, the Community Partnership At frames what has become known as the institutions of society civil-with the state does not eliminate the role, but rather complements its role ; it is the role of civil society partner and an extension of the role of the state in the face of challenges and crises, but it may be sometimes a race role in addressing social, political and economic issues of the role played by the state, not complementary.
The highlighting the specificity of the relationsh
Rheumatoid arthritis (RA) is a common inflammatory disease that associated with increased morbidity and mortality due to accelerated atherosclerosis. Rosuvastatin is a unique hydroxy methyl glutaryl Co A (HMGCoA) reductase inhibitor that has anti inflammatory effects.
The aim of this study was to evaluate the effect of rosuvastatin as adjuvant therapy to methotrexate (MTX) on lipid profile and its possible cardioprotective effect in RA patients. A double blinded placebo controlled clinical trial with 8 weeks follow up periods at which 40 patients with active RA using MTX were randomized into 2 groups to receive either rosuvastatin 10mg or placebo as adjuvant therapy to MTX. In addition to twenty healthy subjects as control group.
... Show MoreThe tax base is one of the bases of the technical organizing of taxes, and that a good selection of the tax base effects the outcome of the tax and its fairness, and with the expansion of the tax range results a dangerous phenomenon called tax evasion, which became threaten the economies of countries and this phenomenon prevents the achievement of the state to its economic, political and social objectives which seeks to resolve this phenomenon and identifying all human and material potential and realize the real reasons that lie behind it. The researcher found that tax authorities are weak in terms of it the technical material and financial abilities, the analysis of data show that then is a significant reve
... Show MoreUrinary tract infection is a bacterial infection that often affects the bladder and thus the urinary system. E. coli is one of the leading uropathogenic bacteria that cause urinary tract infections. Uropathogenic E. coli is highly effective and successful in causing urinary tract infections through biofilm formation and urothelial cell invasion mechanisms. Other organisms that cause urinary tract infections include members of the Enterobacteriaceae family, streptococci and staphylococci species and perch. In addition, K.penumoniae is another important gram-negative bacterium that causes urinary tract infections. With the PCR technique, unseen bacterial species can be detected using standard clinical microbiology methods. In this study, the
... Show MoreA field experiment was carried out at University of Baghdad, College of Agricultural Engineering Sciences during fall season of 2020 and spring season of 2021. This study was aimed evaluate the effect of the organic fertilizer and boron foliar on the yield of potatoes for processing. The factorial experiment (5*4) within RCBD and three replicates. The organic fertilizer as palm peat at four levels (0, 12, 24 and 36 ton. ha-1) in addition to the chemical fertilizer recommendation treatment. Boron at four Concentrations 0, 100, 150 and 200 mg. L-1 . The results revealed significant different among application of organic fertilizer at the level of 24 ton. ha-1 and the foliar application of boron at a concentration of 100 mg. L-1 in the
... Show MoreABSTRACT: BACKGROUND: Left ventricular hypertrophy is a significant risk factor for cardiovascular complications such as ischemic heart disease, heart failure, sudden death, atrial fibrillation, and stroke. A proper non-expensive tool is required for detection of this pathology. Different electrocardiographic (ECG) criteria were investigated; however, the results were conflicting regarding the accuracy of these criteria. OBJECTIVE: To assess the accuracy of three electrocardiographic criteria in diagnosis of left ventricular hypertrophy in adult patients with hypertension using echocardiography as a reference test. PATIENTS AND METHODS: This is a hospital-based cross sectional observational study which included 340 adult patients with a his
... Show MoreThose interested in the educational process and lesson management sought to invest the information experience with industrial intelligence and technology because of its importance in increasing the effectiveness of lesson management and developing the creative capabilities of the teacher in directing and managing his lesson. Field research for sports educational institutions that are interested in managing the lesson and preparing mathematical teaching cadres is an important issue and necessary means for identifying the most important phenomena that accompany the process of managing the educational process, as the teacher's success in providing the appropriate conditions to provide rich and influencing experiences in managing and directing
... Show MoreAt the last two decades , The environment has witnessed tremendous changes in many fields with the huge competition , various technological development and customer satisfaction , that are reflected in economic units a doption for lean production system .
Lean Accounting that has appeared as aresponse for changes occurred of economic units adoption for lean accounting system instead of wide production system : through it management of economic units has been changed from management by top departments into management by value flows : has provide new method for accounting costs according to value flow
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