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.
Abstract
Performance evaluation is of great importance in all countries of the world, because it has a prominent and effective role in determining the efficiency and effectiveness of the optimal use of available resources, which are rare and important in achieving the desired objectives. With the continued growth of public spending and the limited resources, the State seeks to achieve its objectives through its units with minimal expenditure or deficit, rationality and wastefulness in the spending. In many countries, particularly developing countries, reforms are made in the public sector to achieve that goal through the adoption of IPSAS, which is reflected in the developmen
... Show MoreThe size and the concentration of the gold nanoparticles (GNPs)
synthesized in double distilled deionized water (DDDW) have been
found to be affected by the laser energy and the number of pulses.
The absorption spectra of the nanoparticles DDDW, and the
surface plasmon resonance (SPR) peaks were measured, and found to
be located between (509 and 524)nm using the UV- Vis
spectrophotometer. SPR calculations, images of transmission
electron microscope, and dynamic light scattering (DLS) method
were used to determine the size of GNPs, which found to be ranged
between (3.5 and 27) nm. The concentrations of GNPs in colloidal
solutions found to be ranged between (37 and 142) ppm, and
measured by atomic absorptio
Background: There are so many evidences that there was antimicrobial resistance, and there were many strains that emerged which were difficult to treat. We are living in a situation that the dissemination of multiple drug resistant bacteria can lead us to the situation, in which no treatment could be offered for bacterial infection in future.
Aim of study: Assessment of nurses’ knowledge, attitude, and practices on antibiotic use and resistance in Fatima Al Zahra hospital in Baghdad.
Subjects and Methods: A cross-sectional study. The study was carried on from 1st of February to 31st of March 2021. A questionnaire was constructed by the research team based on literature review and was adapted to asses
... Show MoreAccelerates operating managements in the facilities contemporary business environment toward redefining processes and strategies that you need to perform tasks of guaranteeing them continue in an environment performance dominated by economic globalization and the circumstances of uncertainty attempt the creation of a new structure through multiple pages seek to improve profitability and sustainable growth in performance in a climatefocuses on the development of institutional processes, reduce costs and achieve customer satisfaction to meet their demands and expectations are constantly changing. The research was presented structural matrix performance combines methodology Alsigma in order to improve customer satisfaction significantly bet
... Show MoreTo perform a secure evaluation of Indoor Design data, the research introduces a Cyber-Neutrosophic Model, which utilizes AES-256 encryption, Role-Based Access Control, and real-time anomaly detection. It measures the percentage of unpredictability, insecurity, and variance present within model features. Also, it provides reliable data security. Similar features have been identified between the final results of the study, corresponding to the Cyber-Neutrosophic Model analysis, and the cybersecurity layer helped mitigate attacks. It is worth noting that Anomaly Detection successfully achieved response times of less than 2.5 seconds, demonstrating that the model can maintain its integrity while providing privacy. Using neutrosophic sim
... Show MoreThe Light and the Dark is the fourth novel in a series written by Charles Percy Snow where it tackles a phase of gifted scholar and remarkable individual Roy Calvert as he search for a source of power and meaning in life to relieve his inner turmoil. The character Roy Calvert is based on Snow's friend, Charles Allbery who exposes the message the character of Roy intends to convey in a certain phase of his life and the prophecy the novel carries amid catastrophe so widespread in the thirties of the twentieth century
This paper presents the Extended State Observer (ESO) based repetitive control (RC) for piezoelectric actuator (PEA) based nano-positioning systems. The system stability is proved using Linear Matrix Inequalities (LMIs), which guarantees the asymptotic stability of the system. The ESObased RC used in this paper has the ability to eliminate periodic disturbances, aperiodic disturbances and model uncertainties. Moreover, ESO can be tuned using only two parameters and the model free approach of ESO-based RC, makes it an ideal solution to overcome the challenges of nano-positioning system control. Different types of periodic and aperiodic disturbances are used in simulation to demonstrate the effectiveness of the algorithm. The comparison studi
... Show MoreMobile ad hoc network security is a new area for research that it has been faced many difficulties to implement. These difficulties are due to the absence of central authentication server, the dynamically movement of the nodes (mobility), limited capacity of the wireless medium and the various types of vulnerability attacks. All these factor combine to make mobile ad hoc a great challenge to the researcher. Mobile ad hoc has been used in different applications networks range from military operations and emergency disaster relief to community networking and interaction among meeting attendees or students during a lecture. In these and other ad hoc networking applications, security in the routing protocol is necessary to protect against malic
... Show MoreB3LYP density functional is utilized for probing the effect of decorating Al, Ga, and In on the sensing performance of a boron phosphide nanotube (BPNT) in detecting the 2-chloroethanol (CHE) molecule. We predict that the interaction of pure BPNT with CHE is physisorption, and the sensing response (SR) of BPNT is approximately 6.3. The adsorption energy of CHE is about − 26.3 to − 91.1, − 96.6, and − 100.3 kJ/mol, when the Al, Ga, and In metals are decorated on the BPNT surface, respectively. This indicates that the decorated metals significantly strength the interaction. Also, the corresponding SR meaningfully rises to 19.4, 41.0, and 93.4, indicating that by increasing the atomic number of metals, the sensitivity i
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