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.
Refuse derived fuel (RDF) is considered one of the most important types of low cost thermal energy which can be tapped in the industry, especially the cement industry in particular being the need of high thermal energy during the production processes, and in this paper we have implemented the use of a derivative of the fuel RDF as a substitute for gasoline , to reduce production costs and thereby achieve production efficiency, and the methodology used in this research statistical analysis as well as the use of the cost of kaizen target for the purpose of reducing costs and achieve production efficiency, and this has reduced the cost total cement production by which led to reduce total costs of cement production by 8.4% and an incre
... Show MoreThe current research aims to highlight the role of social networking sites in the dissemination of scientific knowledge and the importance of their use by researchers, and the researcher relied on the descriptive approach and the survey method. Among the data collection tools are the questionnaire and paper and electronic sources. Among the most important results that the research came out with: The number of the subscribers’ sites was (14) sites, and the most used social sites for receiving and Disseminating Scientific knowledge are: Facebook, Telegram, WhatsApp, Viber, Messenger and YouTube. All respondents receive tacit knowledge (Exchange of Messages and News) through social networking sites, and few of them do not receive explicit kn
... Show MoreThe current research aims through its chapters to verify the relationship and impact of strategic leadership as an independent variable in the marketing performance as a respondent variable, in a leap cement plant, and try to come up with a set of recommendations that contribute to enhancing the practice and adoption of the two variables in the organization under discussion. And based on the importance of the research topic to the community, and to the researched organization and its members, the analytical and analytical approach was adopted in the completion of this research, and the research community included a leap cement plant in Anbar Governorate, while the research sample was represented by (department heads, and people o
... Show MoreType 2 daibetes mellitus (T2DM) is a global concern boosted by both population growth and ageing, the majority of affected people are aged between (40- 59 year). The objective of this research was to estimate the impact of age and gender on glycaemic control parameters: Fasting blood glucose (FBC), glycated hemoglobin (HbA1C), insulin, insulin resistance (IR) and insulin sensitivity (IS), renal function parameters: urea, creatinine and oxidative stress parameters: total antioxidant capacity (TAC) and reactive oxygen species (ROS). Eighty-one random samples of T2DM patients (35 men and 46 women) were included in this study, their average age was 52.75±9.63 year. Current study found that FBG, HbA1C and IR were highly significant (P<0.01) inc
... Show MoreFibroblast growth factor-23, play an important role in atherosclerosis, endothelial dysfunction and vascular calcification. Sevelamer can improve vascular calcification, serum uric acid, low-density lipoprotein-cholesterol and Fibroblast growth factor-23. Aim of study Assessment the effect of sevelamer as phosphate binder against calcium carbonate on Fibroblast growth factor-23. Methods A prospective open-labelled study that included patients on hemodialysis. A total of 72 patients were screened, only 53 patients completed the 10 week period. Adults patients with serum phosphate as> 5.5 mg/dl were included. There were Group1: Includes 28 patients (19 males and 9 females receiving sevelamer carbonate (Renvela) tablet. Group 2: Include 25pati
... Show MoreAs long as the place in which a person lives has a meaning and temporal dimensions , memory is the main axis of these dimensions , today , city centers and old historical sectors of cities are abandoned , and began to turn into slums , the contradiction between old and historical sectors led cities to lose their identity while people lost their sense of belongingness to the old sectors where their ancestors used to live . The old city of Hilla used to have social , historical and cultural role on determining the identity . The study problem can be summarized as the ( lack of studies regarding the impact of historical memory related to Hilla old city on social and cultural mobility ) , the study hypothesis claims that the social , histori
... Show MoreBased on the theoretical review of researches and studies concerned with virtual teams in organizations, it was found that the role of virtual teams varies from case to another, and it may be positive or opposite. The purpose of the current research is to examine the role of virtual teams in the impact of cultural intelligence on the strategic excellence of Zain worldwide Group. An electronic questionnaire was designed through the (Google) and (Microsoft) forms, and distributed then on a sample of (146) participants with a high organizational level of the HRM departments within the group. The results showed that there was a positive moderator role of virtual teams in the relationship of cultural intelligence and strategic excellence
... 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 MoreBanks face many of the various risks: which are of dangerous phenomena that cause the state achieved a waste of money and a threat to future development plans to be applied to reach the goals set by: prompting banks and departments to find appropriate solutions and fast: and it was within these solutions rely on Banking risk management and effective role in defining and identifying: measuring and monitoring risk and trying to control and take risks is expected to occur in order to encircle and make it in within acceptable limits: and try to avoid them in the future to reduce the losses that are likely to be exposed to the bank: and it began to emerge and dominate a lot of legislation that seeks to structure the year risk management and t
... Show MoreRheumatoid arthritis (RA) is a systematic autoimmune disorder with chronic inflammation changes of unknown etiology. Various synovial inflammatory and proliferative alterations may contribute to the cartilaginous tissues and invasive bony tissues, leading to destructive joints and malformed bones. This disease is mostly due to infective microorganisms or genetic susceptibility causing immune system disturbances through triggering both T-cells and B-cells. Furthermore, different immune cells may secret cytokines, which are responsible for some RA pathogenesis activity. From ninety individuals, serum sample was collected; thirty of them were normal and sixty cases were patients with RA attended a privet medical clin
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