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.
« The emergence of satellite channels has led to fundamental changes in the supposed role of television, making it a center of culture and an important tributary to social upbringing and influencing the attitudes and values of individuals and in making public opinion regarding various issues, some television programs target ordinary people at home by virtue of the nature of their subjects, where there is a large audience of viewers, who consume and absorb what is offered to them from the cultural production of those satellite channels that play with the aspirations of groups of society to find metaphysical or magic solutions to their social problems or psychological delusions. The media, through its various messages, contributes to brin
... Show Moreتسعى المحاسبة الى مسايرة القفزات الهائلة والمتسارعة في تطور العلوم الصرفة والتطبيقية والتقدم التكنولوجي، والتي ادت على ظهور مفاهيم جديدة الغت مسلمات وبديهيات كانت سائدة لمدة طويلة، فعلى سبيل المثال: كان مخزون المواد الاولية والبضاعة التامة في المؤسسات الصناعية او التجارية يشكل العمود الفقري لها بتكاليفه ومشاكله، حتى اذا ما جاء نظام (JIT) الغى بتطبيقاته هذه المفاهيم واعتمد م
... Show MoreActinomycetes are free, spore-forming, high (G+C) ratio (>55%) saprophytic microorganisms that are widely distributed in most soils, colonize plants, and are prevalent in water. This is frequently accompanied by the production of filament airborne mycelium. Actinomycetes are well-known microcolonies for creating antibiotics and other critical bioactive components that are beneficial to humans. Approximately 70% to 80% of commercially available medications and antiviral active compounds have been synthesized so far. Secondary metabolites produced by microbes have the potential to be used in a variety of sectors, including antimicrobial agents, enzyme technology, pigment manufacture, antitumor agents against cancer cells, and toxin pr
... Show MoreThe added value of internal audit greatly contributes to adding value to the institution, but most departments of economic units in Iraq neglected the role of internal audit and the added value that can be achieved by those institutions, since the term added value of internal audit is a relatively vague term from the premise that what cannot be measured is difficult Determine it, and perhaps descriptive standards for it is the extent of compliance with international auditing standards (IIA).
The research aims to study the procedures and results of auditing to verify that they have given an added value to the audit with a positive impact, develop its aspects and research, identify deficiencies for the audi
... Show MoreTransient drop in the heart beat or transient heart block (AVB) may be consider the main cause of syncope or presyncope inpatients with bifascicular block and syncope According to the Guidelines for cardiac pacing pacemaker consider part of treatment. Aims of our study were to evaluate whether there is role for EPS in patients BFB and to evaluate the symptoms after pacing. 42 patients were enrolled in this study, with mean age value (63.4± 12.2years), suffer from interventricular conductive defect and syncope; patients underwent EPS on admission time, and pacemaker implantation accordingly and programmed follow up for the device in the last four years. Our patients were 25 (59.5%) male and 17 (40.5%)female, all of them with syncope o
... Show MoreCholesteryl ester transfer protein gene contains some single nucleotide polymorphisms, which have been associated with serum high-density lipoprotein concentration and other lipoproteins. This study is done for determining of cholesteryl ester transfer protein polymorphism and evaluate its effect on serum lipid profile concentrations in some hyperlipidemic patients compared with healthy subjects in Salah Al-din governorate-Iraq. Blood samples were taken from (90) patients suffering from hyperlipidemia, and (70) samples that were apparently healthy controls. Serum lipid concentrations were measured by enzymatic assays. The polymorphism was genotyped using polymerase chain reaction restriction fragment length polymorphism analysis.&n
... Show MoreBackground: Central serous chorioretinopathy (CSCR) is an idiopathic condition aggravated by exogenous or endogenous glucocorticoids. Vascular deregulation in the choroid is a new hypothesis regarding central serous chorioretinopathy occurrence. The inhibition of choroidal mineralocorticoid receptors has a great role in shortening the duration of CSCR by inhibiting choroidal vasodilatation and leak.
Objective: To assess the effect of oral spironolactone on subretinal fluid, central macular thickness and visual acuity in patients with acute CSCR compared to observation.
Subjects and Methods: a hospital based, randomized clinical trial carried out at outpatient clinic in Ibn-Alhaitham Teaching E
... Show MoreSchool administration has an effective role in stimulating academic achievement, as it is the ideal regulation and activation of material and human power to achieve the goals of the educational process. This role has axes in the form of interests, aids, and specific procedures exercised by the school administration in improving the educational process, and assisting researchers in achieving the highest levels of academic achievement. This activation is achieved through stages of planning, organizing, coordinating, and evaluating.
To achieve the aims of this research, the researcher pursued the descriptive analytical approach, which is considered one of the most appropriate approaches to the nature of this type of research. The qu
... Show MoreThe problem of this study lies in that NATO was formed in the first place to protect Europe from Warsaw Pact. The geographical and military strategy have been changed with the change of its mission and expanding its operation scope with the leadership of the USA in the international scens. The latter has made this organization as the military arm to tighten its control over strategic regions.
The research supposes that NATO state members confront security concerns and political and military issues that push to expand the organization. The importance of this study lies in knowing the new roles of NATO imposed by the United States. Therefore, the continuity and affi
... Show MoreThis research investigates the pre- and post-cracking resistance of steel fiber-reinforced concrete specimens with Glass Fiber Reinforced Polymer (GFRP) bars subjected to flexural loading. The purpose is to modify the ductility and cracking resistance of GFRP-reinforced beams, which are prone to early cracking and excessive deflections instigated by the low modulus of elasticity of GFRP. Six self-compacting concrete specimens (1500×240×200 mm), incorporating steel fibers of two lengths (25 mm and 40 mm) with varying distribution depths, were tested to assess their structural performance. The results indicate significant enhancements in cracking resistance, stiffness, energy absorption, ductility, and flexural strength. Tested beam
... Show More