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.
Purpose The purpose of this study was to evaluate the complications associated with the use of reconstruction plates with or without non-vascularized bone graft in reconstruction of mandibular segmental defects caused by trauma and tumor resection and to analyze various factors that are associated with the development of complications. Methods A retrospective observational study was conducted, and the investigated variables included the age and gender of the patients, etiology of the defect, the site of the defect, the size of the defect, whether bone graft was used or not, type of plate used, and whether the reconstruction was immediate or delayed. The outcome variables were the postoperative complications and the success rate. Results Fif
... Show MoreThe Audit evedances represent the reconciliation tools between the Financial data shown on financial statements, and the level of satisfaction level of the Auditor about these statements. According that, the Auditor try to achieve the highest quantity of These evidances, and the most satisfactive of it…, but that will be so hard sometimes, when the internal controlling system is not good, and when the Auditor had some satisfied evidences, but not sharp… So, this research comes to inspect the relation between the quantity, and the level of satisfaction, and argument to prove that evidences gives. This research assumes that getting enough evidences leads to reduce faults, improves the auditing operation, and avoids risks. The research
... Show MoreThe pharmacist's role in the community is currently directed towards providing drug information and patient care rather than drug compounding and dispensing. Patient counseling is an essential skill for pharmacists. So as to improve the pharmacist role in the community and enhance the patient's education and counseling skills, many continuing education programs are established. The aim of this study is to assess the perceptions and tendency of community pharmacists in Iraq regarding patients counseling and continuing pharmacists’ educational programs.
Tourist business organizations face a challenging and the risks dynamic environment reflected its impact on the community and generate extra under pressure in the responsibilities and burdens of exceptional and affected much of factors, accidents and risks as a result of the actions and attitudes of disasters variety may exceed the geography of States border, which requires the absorption of risks facing the tourism and how to manage and deal with them scientific and reasonable grounds for the diagnosis and treatment of risk and how to reduce the aggravation and the different kinds.
As risks affecting the most important and vital to organizations as a tourist aspects of the market share and styles tourist
... Show MoreThere is a global shortage of health care providers needed to address all levels of primary and specialty care. The recent COVID-19 pandemic also highlights the importance and added value of health professionals with specialty training in infectious diseases. In the United States, advanced practice providers (APPs) are being engaged to meet the expanding demand for generalist and specialist patient care. The history and development of advanced practice registered nurses (APRNs) and physician assistants (PAs), are discussed as collaborative healthcare providers to promote better understanding of the ways they can be incorporated into a healthcare system. An example of how APPs are utilized to provide both inpatient and outpatient
... Show MoreThe study examines the root causes of delays that the project manager is unable to resolve or how the decision-maker can identify the best opportunities to get over these obstacles by considering the project constraints defined as the project triangle (cost, time, and quality) in post-disaster reconstruction projects to review the real challenges to overcome these obstacles. The methodology relied on the exploratory description and qualitative data examined. 43 valid questionnaires were distributed to qualified experienced engineers. A list of 49 factors causes was collected from previous international and local studies. A Relative Important Index (RII) is adapted to determine the level of importance of each sub-criterion in the fou
... Show MoreBackground: The post-operative acute abdominal complication is one of the most difficult clinical problems facing the surgeon, and it represents a unique challenge for him not only because of the difficulty in making a precise diagnosis but also in the decision for further management . Objective: discuss the post-operative acute abdominal complications requiring re-interventionType of the study: Cross sectional study. Methods : Patients with early post-operative Acute Abdominal complications ( within 30 days from the initial operation ) who required re-intervention were studied prospectively Results :The study included 82 patients 47 of them were females, their age ranging 7-87,Different types of the initial operation were reported,51 %
... Show MorePrenatal markers are commonly used in practice to screen for some foetal abnormalities. They can be biochemical or ultrasonic markers in addition to the newly used cell free Deoxyribonucleic Acid (DNA) estimation. This review aimed to illustrate the applications of the prenatal screening, and the reliability of these tests in detecting the presence of abnormal chromosomes such as trisomy-21, trisomy-18, and trisomy-13 in addition to neural tube defects. Prenatal markers can also be used in the anticipation of some obstetrical complications depending on levels of these markers in the mother’s circulation. In the developed countries, prenatal screening tests are regularly used during antenatal care period. Neural tube defects, numer
... Show MoreStudy the role of CoQ10 and IGFBP-1 in obese male patients with diabetic mellitus type 2. ELISA method was used to assay Serum CoQ10 and IGFBP-1. Blood was taken with drawn sample from 30 obese normal patients with age range (40-60) years, 30 diabetic patients with age range (40-60) years at duration of disease (1-5) years and 30 normal healthy patients. The mean difference between T2DM according to CoQ10 (12.5±1.1) was decreased than the mean of IFG (21.8±3.2) (P 0.002) and the mean difference between T2DM according to IGFBPs (0.65±0.06) was decreased than the mean of IFG (3.2±0.3) (P 0.000). While no significant difference between mean age of DM2 patients (55.5±1.06), and IFG (55.6±0.9) (p 0.90), no significant difference bet
... Show MoreThe acute phase response is a major pathophysiologic phenomenon that accompanies inflammation whether acute or chronic. Complement (C3 and C4) and C - reactive protein (CRP) are positive acute phase proteins (+ ve APPs ). Their production takes place in hepatocyte and the blood concentration of these parameters are increased in osteoarthritis (OA). Chloroquine (CQ) is a diprotic weak base traditionally used to treat malaria. Recently the phosphate salt of CQ is used to decrease this type of (+ve APPs) . In this study, patients who suffered from knee osteoarthritis (KOA) are treated with oral dosage form of chloroquine phosphate (CQP) for one month, twice daily. Our results demonstrate that CQP improves the patient status by decreas
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