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.
Chronic lymphocytic leukaemia (CLL) patients display a highly variable clinical course, with progressive acquisition of drug resistance. We sought to identify aberrant epigenetic traits that are enriched following exposure to treatment that could impact patient response to therapy.
Epigenome-wide analysis of DNA methylation was performed for 20 patients at two timepoints during treatment. The prognostic significance of differentially methylated regions (DMRs) was assessed in independent cohorts of 139 and 1
This study aimed to determine the effects of age, gender, and allergen type on serum immunoglobulin E (IgE) levels in asthma (AS) and allergic rhinitis (AR) patients. Sixty AS patients, 52 AR patients, and 61 controls were enrolled in the study. Sera of participants were assessed for total IgE level and specific IgE antibody against four allergen types (animal dander, grasses, mites, and molds). The results revealed that median level of total IgE was significantly increased in AS (218.9 IU/mL; p-value < 0.001) and AR (244.3 IU/mL; p-value < 0.001) patients compared to controls (167.1 IU/mL), while, there was no significant difference between AS and AR patients (p-value = 0.270). Logistic regression
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The internal control is the tool through which it is possible to verify and ensure the implementation of tasks in accordance with the established plans and programs and to evaluate the level of performance that is implemented within the different companies.
A guarantee from the supplier with the absence of a specialized technical committee that follows up the stages of implementing the contract and disbursing all amounts of financial dues to the supplier before completing the implementation of the contract and overlooking the non-implementation of some clauses of the contract by the committee in charge of
... Show MoreThis study deals with the serviceability of reinforced concrete solid and perforated rafters with openings of different shapes and sizes based on an experimental study that includes 12 post-fire non-prismatic reinforced concrete beams (solid and perforated). Three groups were formed based on heating temperature (room temperature, 400 °C, and 700 °C), each group consisting of four rafters (solid, rafters with 6 and 8 trapezoidal openings, and rafter with eight circular openings) under static loading. A developed unified calculation technique for deflection and crack widths under static loading at the service stage has been provided, which comprises non-prismatic beams with or without opening exposed to flexure concentra
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The research aims at achieving a set of objectives, which is to study a vital variable in the organizations which is the talent management and its impact on encouraging and empowering employees to take part in making appropriate decisions with their heads in the Iraqi Cement State Company. The problem of this research is in finding solutions to the weaknesses that face the managers in attracting talented employees and keep them in the company, and this leads to a weak capacity of the company on authorizing talented employees and giving them the needed confidence to participate in decision making process. The research sample was included (45) managers in the researched company. Th
... Show MoreThis study aimed to clarify the legal provisions concerning the senses and their role in financial transactions, in the light of the definition of all the vocabulary presented by this study (senses - the definition of senses apparent: they are hearing - sight - smell - taste - touch) in the first section. The study deals with the second topic of the reference and writing denominator phrase and includes two requirements, the first requirement: the establishment of the denominator of the phrase, which has two branches: Section I: signal Akhras. Section II: Signal of the Spokesman.
The second requirement is that writing takes the place of the phrase in financial transactions. The owners argue that the sale of the blind is correct a
Phraseological or phraseological turn - unchanged in structure and composition, integral in meaning and lexically indivisible phrase or sentence, performing the function of a separate dictionary unit - lexemes. Idioms are found in any language of the world. But such a number of winged phrases, as in Russian, is nowhere else. Idioms play a role in displaying the national-cultural characteristics of any language. They very clearly and accurately reflect the characteristics of the perception of the world, the characteristic features of the material and spiritual life of native speakers, his mentality.
The Islamic religion approach Rabbani urges and seeks to bring happiness to people, as Allah says: ((We sent thee not all people glad tidings and a warner, but most people do not know)) Spa: State 28
Islam looks at the concept of educational values through positive behavior derived emerging through formal and informal education. The Islamic approach works on the basis of a systematic and clear rule in the form of an integrated system includes multiple areas. As the lead actor role as the desired position.
Although