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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
Wed Jun 29 2016
Journal Name
Iraqi Journal Of Market Research And Consumer Protection
Effect of adding the Flavonoids from Zizypus spina-christi leaves in redox indicators of the fat extracted from Cows, Sheeps bones and storage on defferent temperature and periods.: Effect of adding the Flavonoids from Zizypus spina-christi leaves in redox indicators of the fat extracted from Cows, Sheeps bones and storage on defferent temperature and periods.
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Flavonoids were extracted from Zizyphus spina-christi leaves by Ethyl acetate after acid digested and used as antioxidant. The dried extract was added separately to each sample of fat extracted from hallow cow and sheep bones as follows: T1 cow fat, T2 control for cow fat, T3 sheep fat and T4 control for sheep fat (the control T2 and T4 reffered to samples without added antioxidant).
Samples were stored at -18, 5, 25 and 55 °C for 28 days. The storage trials were conducted at -18, 5 and 25 °C for 28 days for T1, T2, T3 and T4. The chemical indices examined initially and at the end of storage period. PVs was 1.46, 1.46, 1.8 and 1.8 meq/ Kg oil respectively, FFA values were 0.245, 0.245, 0.244 and 0.244% respectively and TBA va

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Publication Date
Sat Sep 30 2023
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The role of the tax examiner's procedures in increasing or decreasing tax revenue : Applied research in the General Authority for Taxes
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Abstract:

               The tax is one of the elements of the general revenues of the state and contributes to covering its expenses. Taxes are imposed in most countries of the world. The tax proceeds depend on a set of factors that contribute either positively or negatively to the tax share by increasing or decreasing it. Therefore, the research aims to demonstrate the role of the tax examiner's procedures in achieving the validity of the taxable base and its reflection on the tax proceeds, as well as reviewing the tax examiner's procedures related to the tax return process. Examination and tax audit of the financial statements, as well as presenting the financial statements to an independent and i

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Publication Date
Tue Dec 11 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Evaluation of Nursing staff Performance in Cardiac Care Units at Teaching and Non Teaching Hospitals in Kirkuk City: A Comparative Study
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Objective: The descriptive study was used to evaluate nursing staff performance in cardiac care units at teaching
and non teaching hospitals in kirkuk city: A comparative study.
Methodology: A descriptive study was used to evaluate nursing staff performance in cardiac care units. The study
was conducted from December 29th
, 2013 up to the 27th of Apr. 2014. A non-probability (purposive) sample of
(44) nurses who work in cardiac care unit at Azady teaching Hospital and Kirkuk general Hospital was evaluated by
a questionnaire which consisted of two parts; the first part is concerned with the demographic characteristics of
the nurses and the second part concerned Observation check list for evaluation nursing staff Perfo

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Publication Date
Sat Jun 18 2022
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Anti-Inflammatory Activity of Gingko Biloba Extract in Cotton Pellet-Induced Granuloma in Rats: A comparative Study with Prednisolone and Dexamethasone
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The current study was designed to evaluate the anti-inflammatory effect of GKB in the rat model of granulomatous inflammation. Thirty rats were distributed into five groups:  The first group served as negative control group that received distilled water (DW) only without inducting inflammation, positive control group; treated with DW with the induction of inflammation and they were assigned to cotton pellet-induced granuloma, ginkgo biloba (GKB) treated group (200mg/kg/day), dexamethasone-treated group (1mg/kg), and Prednisolone treated group (5mg/kg). All the treatments were given orally for seven consecutive days.  On day eight, the rats were anesthetized and the pellets together with granulation tissue were carefully removed

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Publication Date
Sun Jul 02 2023
Journal Name
Nanomedicine Research Journal
Gold and Silver Nanoparticles with Modified Chitosan /PVA : Synthesis, Study The Toxicity and Anticancer Activity
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The new novel polymers nanocomposites based modified chitosan (CS) blending with polyvinyl alcohol (PVA) and coated gold or silver nanoparticles (AuNPs), AgNPs) were synthesized from many sequence reactions as presented in (Scheme1, 2 and 3). By utilizing 1H-NMR spectroscopy, FTIR, and Field Emission Scanning electron microscope , the synthesized compounds have been identified. Molecular docking is studied, where operations are used to predict the binding status of compounds with the enzyme and to calculate the free energy (ΔG) of the compounds prepared. Also, the antibacterial activity regarding the synthesized compounds against two resistant pathogenic bacteria (G+) S. aureus and E. coli (G-) was examined in vitro compare with standard a

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Publication Date
Wed May 02 2018
Journal Name
Chempluschem
The Oxidation of Peroxide by Disordered Metal Oxides: A Measurement of Thermodynamic Stability “By Proxy”
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It is often noted that disordered materials have different chemical properties to their more “ordered” cousins. Quantifying these effects in terms of thermodynamics is challenging in part because disordered materials can be difficult to characterize and are frequently relatively unstable. During the course of our experiments to understand the effects of disorder in catalysts for water oxidation we observed that many disordered manganese and cobalt oxide water oxidation catalysts directly oxidized peroxide in contrast to their more ordered analogues which catalyzed its disproportionation, that is, MnO2+2H+ +H2O2! Mn2+ +2H2O+O2(oxidation) versus H2O2!H2O+1=2 O2(disproportionation). By measuring the efficiency for one reaction over the oth

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Publication Date
Mon Jan 01 2024
Journal Name
2nd International Conference For Engineering Sciences And Information Technology (esit 2022): Esit2022 Conference Proceedings
Ideals of the full transformation semigroup of a free left G-act on n-generators
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Publication Date
Mon Feb 01 2021
Journal Name
Iop Conference Series: Materials Science And Engineering
Performance Evaluation of a Combined Electrocoagulation– Electrooxidation Process for the Treatment of Petroleum Refinery Wastewater
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Abstract<p>The present study investigates the application of a combined electrocoagulation-electrooxidation (EC-EO) process for the treatment of wastewater generated from Al-Dewaniya petroleum refinery plant in Iraq. The EC-EO process was examined in terms of its ability to simultaneously produce coagulant and oxidant agents by using a parallel plate configuration system composed of stainless steel plates as cathode and pair of aluminum and graphite plates as anode at two different current concentrations (1.92A/l and 0.96A/l). The results showed that the best conditions for treatment of Al-Dewaniya petroleum refinery wastewater using the combined approach were current concentration of (0.96A/l), current density</p> ... Show More
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Publication Date
Thu Nov 21 2024
Journal Name
Al Rafidain Journal Of Engineering Sciences
A Review of the Effect of Crumb Rubber as an Additive on Hot Mix Asphalt
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Materials recycling has a significant economic and environmental impact; as a result, steel, aluminium, plastic, and other recyclable materials have been pushed for use in construction materials. One of these recyclable materials is the crumb rubber, has been considered as a pavement component. The general behaviour of the composite rubber-hot mix asphalt system would be varied from that of the conventional rubber free mix. In this review, desirable characteristics of hot mix asphalt are highlighted first. Also, effect of gradation and the main types of rubber are specified. Afterward, many studies that considered the crumb rubber as a waste product and its associated mixture and modifiers are reviewed. The factors affect the crumb

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Publication Date
Tue Jul 11 2017
Journal Name
The 39th Annual International Conference Of The Ieee Engineering In Medicine And Biology Society (embc'17)
Higuchi fractal dimension of the electroencephalogram as a biomarker for early detection of Alzheimer's disease
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It is widely accepted that early diagnosis of Alzheimer's disease (AD) makes it possible for patients to gain access to appropriate health care services and would facilitate the development of new therapies. AD starts many years before its clinical manifestations and a biomarker that provides a measure of changes in the brain in this period would be useful for early diagnosis of AD. Given the rapid increase in the number of older people suffering from AD, there is a need for an accurate, low-cost and easy to use biomarkers that could be used to detect AD in its early stages. Potentially, the electroencephalogram (EEG) can play a vital role in this but at present, no reliable EEG biomarker exists for early diagnosis of AD. The gradual s

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