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jkmc-963
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
Thu Jun 01 2006
Journal Name
Journal Of The College Of Languages (jcl)
The Image of the Anti- Hero in James Joyce's Ulysses
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The hero traditionally has such admirable traits as courage, fortitude,
chivalry and patriotism. In the literary works, the hero is the leading
character and the pivot around which all the characters and the events
revolve. The characteristics of the hero usually reflect the cultural values
of his time. Because, in each age, Man's attitudes towards himself and the
world change, different images of the hero emerge.
In Greek Mythology, the hero is frequently favoured by the gods;
therefore, he is himself semi-divine. The Greek hero is of princely birth
and is endowed with good physique, exceptional strength, skill in
athletics and battle, energy and eloquence, like Odysseus who is the hero
of the Odyssey, long

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Publication Date
Wed Jan 01 2014
Journal Name
Journal Of The College Of Languages (jcl)
Symbolism in Nathaniel Hawthorne’s The House of the Seven Gables
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Nathaniel Hawthorne is famous for his psychological and moral themes. He is also famous for using symbolism in presenting his poignant themes of sin and its consequences. This research paper studies the use of symbols in Hawthorne's The House of Seven gables as an example of his general use of symbolism in his novels. The general pattern of Hawthorne's symbolism is that he presents one major symbol that embodies the main idea, and supports it with a number of minor symbols that develop and elucidate it. In The House of the Seven Gables, the major symbol is the house itself, which stands for corruption, evil, and the injustice of the past. This symbol is supported by such secondary symbols as the heart, the fountain, the

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Publication Date
Sat Mar 26 2022
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Dual use of Altman financial failure prediction analysis and stress tests to achieve integration in banking risk management : Analytical study of the National Bank of Iraq
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The research aims to demonstrate the dual use of analysis to predict financial failure according to the Altman model and stress tests to achieve integration in banking risk management. On the bank’s ability to withstand crises, especially in light of its low rating according to the Altman model, and the possibility of its failure in the future, thus proving or denying the research hypothesis, the research reached a set of conclusions, the most important of which (the bank, according to the Altman model, is threatened with failure in the near future, as it is located within the red zone according to the model’s description, and will incur losses if it is exposed to crises in the future according to the analysis of stress tests

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Publication Date
Sat Jul 20 2019
Journal Name
Open Access Macedonian Journal Of Medical Sciences
Prevalence of Montelukast Use as an Add-On Therapy among Iraqi Asthmatics on Treatment Attending Al-Kindy Teaching Hospital and Al-Zahraa Center of Asthma and Allergy
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BACKGROUND: Montelukast (Singulair) is a cysteinyl leukotriene receptor antagonist, used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergic rhinitis and asthma, also used for exercise-induced bronchospasm. AIM: This study was performed to determine the prevalence of Montelukast use as an add-on therapy among Iraqi asthmatic patients on treatment. Comparing the effectiveness of regimens with and without montelukast. METHODS: This descriptive cross-sectional study was carried out on 73 Iraqi asthmatic patients on treatment of both sexes with age range (18-60) years old, attending Al-Kindy Teaching Hospital and Al-Zahraa Centre of Asthma and Allergy, Baghdad, for the period between February

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Publication Date
Sat Jul 20 2019
Journal Name
Open Access Macedonian Journal Of Medical Sciences
Prevalence of Montelukast Use as an Add-On Therapy among Iraqi Asthmatics on Treatment Attending Al-Kindy Teaching Hospital and Al-Zahraa Center of Asthma and Allergy
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BACKGROUND: Montelukast (Singulair) is a cysteinyl leukotriene receptor antagonist, used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergic rhinitis and asthma, also used for exercise-induced bronchospasm. AIM: This study was performed to determine the prevalence of Montelukast use as an add-on therapy among Iraqi asthmatic patients on treatment. Comparing the effectiveness of regimens with and without montelukast. METHODS: This descriptive cross-sectional study was carried out on 73 Iraqi asthmatic patients on treatment of both sexes with age range (18-60) years old, attending Al-Kindy Teaching Hospital and Al-Zahraa Centre of Asthma and Allergy, Baghdad, for the period between February

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Publication Date
Sun Jun 01 2014
Journal Name
Journal Of Economics And Administrative Sciences
Measuring and Analyzing of the Relationship between the Financial Development, Economic growth, and Poverty in Iraq with the Autoregressive Distributed lag Model framework for the period (1980-2010)
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The developed financial system is essential for increasing economic growth and poverty reduction in the world. The financial development helps in poverty reduction indirectly via intermediate channel which is the economic growth. The financial development enhancing economic development through mobilization of savings and channel them to the most efficient uses with higher economic and social returns. In addition, the economic growth reduces the poverty through two channels. The first is direct by increasing the introduction factors held by poor and improve the situations into the sectors and areas where the poor live. The second is indirect through redistribution the realized incomes from the economic growth as well as the realiz

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Publication Date
Sun Jun 01 2014
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The role of tax policy in the development of the Iraqi economy: (Applied Research for the period from 1995 to 2010)
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The tax policy is an important tool of fiscal policy tools which is usedasits multiple tools the State seeks to achieve objectives, such as theachievement of economic development.The importance of the research comes from the importance ofeconomic development resulting from economic policies and prudent fiscaland appropriate to the economic situation of Iraq at the moment is the mostimportant tax policy that taxes one of the most important financial instruments.The research aims to clarify the role of tax policy in developing of theIraqi economy.In an effort to achieve the goals researchers tried to prove thehypothesis ((The tax policy and through multiple tools that seeks to contributeto the achievement of economic development in Iraq)).

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Publication Date
Sun Jan 27 2019
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The ImpactOf Managerial Control To Increase The Efficiency Of The Tax View: An Applied Research In The General Commission Of Taxes
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The research tried to show the importance of  Administrative Control being one of the important means in administrative work; they work on the review and audit work done and error handling explored in the work and prevent the occurrence and ascertain the extent of implementation of the planned targets, and therefore this is reflected in raising the efficiency of the performance of the tax examiner and complete the work as soon as possible and the highest efficiency and reduce the gaps that may occur between the parties of the tax settling accounts and dealt with in the theoretical side of the search to the research problem, namely with whether operating management oversight to improve the performance and increase the efficiency of t

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Publication Date
Thu Sep 30 2021
Journal Name
Journal Of Economics And Administrative Sciences
The Reflection of the Adoption of IFRS 17 “Insurance Contracts” on the Procedures for Auditing Insurance Contracts in the Iraqi Environment
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          IFRS 17 aims to provide a unified basis for accounting for all types of insurance contracts, including reinsurance contracts, in a manner that benefits both investors and insurance companies and enhances the ability of the financial statements of insurance companies for comparison between companies listed in financial markets around the world. According to this standard, insurance contracts are accounted for on the basis of the Asset-Liability Approach and the use of fair values that the standard requires updating regularly in order to provide more useful information to the users of financial statements, as a result of the failure of reporting requirements for insurance contr

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Publication Date
Sat Jan 31 2026
Journal Name
Modern Sport
Altmtip impact exercises in raising the dynamic range of the skill of the backward straight step down on the balance beam.
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