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The Surgical outcomes of fundus-first technique in lowering the rate of bile duct injuries and bleeding during open cholecystectomy that facing intraoperative difficulties: A single-center prospective study: The surgical outcomes of open fundus-first cholecystectomy technique.
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Background: The problem of difficult gallbladder is not clearly defined and associated with real missing of therapeutic approaches that decreased morbidity. Moreover, the difficult gallbladder was reported as a contributing risk factor for biliary injury due to raised difficulty in surgical dissection within Calot’s triangle. The aim of this study is to determine the surgical outcomes of the open fundus-first cholecystectomy in lowering the rate of lethal intraoperative risks.

Subjects and Methods: Our prospective study conducted during the period of January 2019 to December 2022 at Ibn Sina specialized hospital, Khartoum, Sudan, for two hundred and fifty-three patients underwent elective open fundus-first cholecystectomy for intraoperative difficulties.

Results: the majority of cases had long-standing cholelithiasis with intraoperative difficulties revealed by pre-operative TUS and MRCP which required open fundus-first cholecystectomy in 173 (68.4%) of patients, (P-value <0.05). The operative surgical time was 120 minutes in 103 patients (40.7%), (P-value <0.05). During open cholecystectomy, variable intraoperative difficulties were found in all patients, (P-value <0.05) and were divided into: (A) Contracted intra-hepatic gallbladder seen in 157 (62.1%) of cases; (B) Distorted anatomy within Calot's triangle seen in 135 (53.4%) of patients; and (C) Intraoperative bleeding from the liver bed was observed as bloody oozing form in 150 (59.3%) of cases. Our patients had minimal postoperative complications like mild wound infection in 8 (3.2%) of cases and mortality rate was zero. 

Conclusions: There is a need for appropriate therapeutic and preventive strategies in healthcare systems for safe dealing with difficult cholecystectomy. Unclear anatomy due to severe inflammatory dense adhesions at Calot’s triangle and CBD stones needing difficult surgeries are the most important limiting factors for fundus-first laparoscopic cholecystectomy. Hence, we humbly recommend an open approach of fundus-first cholecystectomy as safe surgical option to reduce the incidence of bile duct injuries and intra-operative bleeding.

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Publication Date
Sun Jun 27 2021
Journal Name
Journal Of The College Of Education For Women
Persuasive Strategies in WHO COVID-19 Virtual Press Conferences: فراس مجيت حماد , جمعة قادر حسين
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Persuasion is an indispensable skill in everyday life; that is why, it has aroused researchers’ interest. This study aims to investigate the most frequently used persuasive strategies in texting WHO COVID-19 Virtual Press Conferences and explore how these strategies are employed to achieve persuasive messages.To this end, a text of WHO COVID-19 Virtual Press Conferences has been chosen randomly to be analyzed based on Dillard and Shen’s (2013) “Persuasive strategies in Health Campaigns”. A qualitative method has been adopted in analyzing the selected data to investigate the credibility and validity of the persuasive strategies used in such a domain. Findings have shown that most of the persuasive appeals based on the adopted mode

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Publication Date
Wed Jul 31 2019
Journal Name
Journal Of Engineering
Enhancing Heat Transfer in Tube Heat Exchanger by Inserting Discrete Twisting Tapes with Different Positions
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Enhancement of heat transfer in the tube heat exchanger is studied experimentally by using discrete twisted tapes. Three different positions were selected for inserting turbulators along tube section (horizontal position by α= 00, inclined position by α= 45 0 and vertical position by α= 900). The space between turbulators was fixed by distributing 5 pieces of these turbulators with pitch ratio    PR = (0.44). Also, the factor of constant heat flux was applied as a boundary condition around the tube test section for all experiments of this investigation, while the flow rates were selected as a variable factor (Reynolds number values vary from 5000 to 15000). The results s

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Publication Date
Sun Dec 01 2019
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Using stress tests to manage credit concentration risks: An applied research in Sumer Commercial Bank
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The research aims to identify banking stress tests, which is one of the modern and important tools in managing banking risks by applying the equations of that tool to the sample. The banking sector considered one of the most vulnerable to sudden and rapid changes in an unstable economic environment, making it more vulnerable. Therefore, it is necessary to establish a special risk management section to reduce the banking risks of the banking business that negatively affect its performance.

The research concluded that there is a direct relationship between stress tests and risk management, as stress tests are an essential tool in risk management. They also considered a unified approach in managing bank risks that helps the bank to

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Publication Date
Wed Aug 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
Proposed Measure for Effect Size in Mediation Analysis with Solution to Some Mediation Process Problems
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In this paper, the effect size measures was discussed, which are useful in many estimation processes for direct effect and its relation with indirect and total effects. In addition, an algorithm to calculate the suggested measure of effect size was suggested that represent the ratio of direct effect to the effect of the estimated parameter using the Regression equation of the dependent variable on the mediator variable without using the independent variable in the model. Where this an algorithm clear the possibility to use this regression equation in Mediation Analysis, where usually used the Mediator and independent variable together when the dependent variable regresses on them. Also this an algorithm to show how effect of the

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Publication Date
Sat Aug 17 2013
Journal Name
American Journal Of Pharmacological Sciences
Pentoxifylline as Adjuvant Therapy to Etanercept in Patients with Moderately to Highly Active Rheumatoid Arthritis
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Publication Date
Thu Nov 16 2017
Journal Name
Joiv : International Journal On Informatics Visualization
Multilayered Framework to Enhance Management Information Systems Decision on Sensitive Data in Cloud Computing Environment
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The purpose of this research is defining the main factors influencing on decision of management system on sensitive data in cloud. The framework is proposed to enhance management information systems decision on sensitive information in cloud environment. The structured interview with several security experts working on cloud computing security to investigate the main objective of framework and suitability of instrument, a pilot study conducts to test the instrument. The validity and reliability test results expose that study can be expanded and lead to final framework validation. This framework using multilevel related to Authorization, Authentication, Classification and identity anonymity, and save and verify, to enhance management

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Publication Date
Tue Jun 30 2020
Journal Name
Association Of Arab Universities Journal Of Engineering Sciences
Immiscible CO2-Assisted Gravity Drainage Process for Enhancing Oil Recovery in Bottom Water Drive reservoir
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The CO2-Assisted Gravity Drainage process (GAGD) has been introduced to become one of the mostinfluential process to enhance oil recovery (EOR) methods in both secondary and tertiary recovery through immiscibleand miscible mode. Its advantages came from the ability of this process to provide gravity-stable oil displacement forenhancing oil recovery. Vertical injectors for CO2 gas have been placed at the crest of the pay zone to form a gas capwhich drain the oil towards the horizontal producing oil wells located above the oil-water-contact. The advantage ofhorizontal well is to provide big drainage area and small pressure drawdown due to the long penetration. Manysimulation and physical models of CO2-AGD process have been implemented

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Publication Date
Mon Oct 31 2022
Journal Name
International Journal Of Intelligent Engineering And Systems
Robot Path Planning in Unknown Environments with Multi-Objectives Using an Improved COOT Optimization Algorithm
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Publication Date
Fri Oct 26 2018
Journal Name
Al–bahith Al–a'alami
University youth attitudes towards mobile phone Companies advertisements in Social networking sites): :(Facebook as sample
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The advertising has emerged as an effective force and an effective instrument upon with all organizations and companies depend on achieving their goals. In additional to the need to use promote sales, The nature and objective of advertising go beyond the scope of specific personal communication to a broader and more effective range for consumers from multiple groups and combination play need to use as well as the need to use means of communication than com convey the message more professional, The coincides with the rapid and remarkable development of all different media technologies and as much as possible social networking sites including mobile phone companies. The advertising has emerged as an effective force and an effective instrum

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Publication Date
Wed Mar 20 2024
Journal Name
Journal Of Petroleum Research And Studies
Advanced Machine Learning application for Permeability Prediction for (M) Formation in an Iraqi Oil Field
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Permeability estimation is a vital step in reservoir engineering due to its effect on reservoir's characterization, planning for perforations, and economic efficiency of the reservoirs. The core and well-logging data are the main sources of permeability measuring and calculating respectively. There are multiple methods to predict permeability such as classic, empirical, and geostatistical methods. In this research, two statistical approaches have been applied and compared for permeability prediction: Multiple Linear Regression and Random Forest, given the (M) reservoir interval in the (BH) Oil Field in the northern part of Iraq. The dataset was separated into two subsets: Training and Testing in order to cross-validate the accuracy

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