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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
Fri Jun 01 2018
Journal Name
Journal Of The College Of Languages (jcl)
A Critical Stylistic Analysis of the Ideological Positioning in Some Selected Poems by John Donne
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This paper deals with the ideological positioning of the English poet John Donne in a selected poems of his i.e Holy Sonnet X, as regards the theme of death found therein. The researchers adopt an emerging branch of stylistics, called Critical Stylistics, as proposed by Jeffries (2010) in order to uncover the ideologies of the author regarding the topic concerned and how linguistic choices are used to slant ideas. The model is comprised of ten tools of analysis which, upon being applied to the selected data, have shown how the poet exploits language resources in order to pass his ideology and influence his readers. In this paper, the workings of only one tool are presented as applied to a certain portion of the data.

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Publication Date
Thu Oct 13 2022
Journal Name
Computation
A Pattern-Recognizer Artificial Neural Network for the Prediction of New Crescent Visibility in Iraq
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Various theories have been proposed since in last century to predict the first sighting of a new crescent moon. None of them uses the concept of machine and deep learning to process, interpret and simulate patterns hidden in databases. Many of these theories use interpolation and extrapolation techniques to identify sighting regions through such data. In this study, a pattern recognizer artificial neural network was trained to distinguish between visibility regions. Essential parameters of crescent moon sighting were collected from moon sight datasets and used to build an intelligent system of pattern recognition to predict the crescent sight conditions. The proposed ANN learned the datasets with an accuracy of more than 72% in comp

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Publication Date
Thu Jul 01 2021
Journal Name
Solar Energy
A new approach for employing multiple PCMs in the passive thermal management of photovoltaic modules
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Publication Date
Thu Aug 01 2019
Journal Name
Journal Of Economics And Administrative Sciences
The cognitive complexity of the leaders and their impact on the organizational flexibility of field research at the company's headquarters for the distribution of petroleum products
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The present research aims to test the effect of cognitive complexity as an independent variable in organizational agility as a responsive variable among the leaders working at the headquarters of the Iraqi Petroleum Products Distribution Company.

 To conclude a number of recommendations that contribute in the organizational agility in the company, and due to the importance of this research in public organizations and its notable role in community organizations. The research was carried out on a random sample of 101 individuals out of a total of 308, which represents the high leaders in the company (general managers, head of departments, and division officials). A questionnaire was used as information

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Publication Date
Tue Dec 01 2020
Journal Name
Baghdad Science Journal
Novel use of XRF in the adsorption processes for the direct analysis of cadmium and silver in absorbent Na-alginate beads
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         The Na-alginate bead is commonly used in biotechnology fields such as adsorption due to ion exchange between Ca and Na with elements. Scanning electron microscopy (SEM-EDX) has proven to be a comparative method in the detections of these adsorbed elements, but the un-flat forming area of beads that can introduce impossible of the detection of element adsorbed. In contrast, X-ray fluorescence (XRF) documents analysis of elements, direct examination, which may analysis the adsorbents of elements. Here, this Study evaluated the possibility by using XRF for the direct analysis for examples of Cd and Ag in a bench stand. This Study compared this to commonly use

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Publication Date
Mon May 21 2007
Journal Name
Journal Of Planner And Development
Determination of levels of interaction between urban land use and the adoption of spatial analysis techniques (study area, Najaf City)
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the student of the structure of the city and its constituent elements will clearly sense the invisible relationships that underlie the different forms of urban activity, which in turn are defined by the generality of the urban patterns in that city, which will vary clearly according to the location in the city. These relations will be embodied in their true form in the interactions between the different uses of the earth, and the change that will result from their regularity in the form of entities in independent groups, which may share with each other a component of it.
Therefore, the process of controlling the functional interactions between the uses of the urban land and the awareness of t

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Publication Date
Sat Sep 30 2023
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The Extent of Applying Corporate Governance Requirements According to International Specification (ISO 26000:2010) in the National Insurance Company: A Research Application
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Abstract

                The research aims to identify the application of corporate governance requirements according to the international standard (ISO 26000:2010) in the National Insurance Company. Strengths and weaknesses were identified to study the current state of this requirement's application in the company under investigation. The descriptive-analytical approach was utilized through a checklist derived from ISO 26000:2010. Several personal interviews and field visits were conducted to understand the extent of application and documentation based on various statistical methods. The results revealed a level of applic

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Publication Date
Sat Nov 13 2021
Journal Name
International Journal Of Pharmacy Practice
A comprehensive review of drivers influencing flu vaccine acceptance in the Middle East over the last six years: using Health Belief Model
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Abstract<sec> <title>Objectives

The objectives of this study were to review the literature covering the perceptions about influenza vaccines in the Middle East and to determine factors influencing the acceptance of vaccination using Health Belief Model (HBM).

Methods

A comprehensive literature search was performed utilizing PubMed and Google Scholar databases. Three keywords were used: Influenza vaccine, perceptions and Middle East. Empirical studies that dealt with people/healthcare worker (HCW) perceptio

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Publication Date
Sat Nov 13 2021
Journal Name
International Journal Of Pharmacy Practice
A comprehensive review of drivers influencing flu vaccine acceptance in the Middle East over the last six years: using Health Belief Model
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Abstract<sec> <title>Objectives

The objectives of this study were to review the literature covering the perceptions about influenza vaccines in the Middle East and to determine factors influencing the acceptance of vaccination using Health Belief Model (HBM).

Methods

A comprehensive literature search was performed utilizing PubMed and Google Scholar databases. Three keywords were used: Influenza vaccine, perceptions and Middle East. Empirical studies that dealt with people/healthcare worker (HCW) perceptio

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Publication Date
Thu Jun 13 2019
Journal Name
Al–bahith Al–a'alami
Media coverage of the 2018 African Youth Games in its third edition in Algeria - An analytical study of Al-Nahar newspaper
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This research revolves around the study of sports press coverage to the third African Youth Games that took place in Algeria from 19 to 28 July 2018. The games featured approximately 3000 athletes from 54 countries who competed in 27 sports. Five sports were qualified for the Youth Olympic Games in Argentina. The aim of this study was to analyze the content of the Algerian newspaper Ennahar El-Djadid by focusing on the discussions of various sports activities during the event. Thus, the descriptive approach and content analysis method were adopted for this research. They were used to highlight the newspaper's interest in this sports phenomenon. The chosen study samples were ten issue numbers of Ennahar El-Djadid newspaper

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