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.
There is a global shortage of health care providers needed to address all levels of primary and specialty care. The recent COVID-19 pandemic also highlights the importance and added value of health professionals with specialty training in infectious diseases. In the United States, advanced practice providers (APPs) are being engaged to meet the expanding demand for generalist and specialist patient care. The history and development of advanced practice registered nurses (APRNs) and physician assistants (PAs), are discussed as collaborative healthcare providers to promote better understanding of the ways they can be incorporated into a healthcare system. An example of how APPs are utilized to provide both inpatient and outpatient
... Show MoreBackground: laparoscopic cholecystectomy (LC) is getting popularity for the treating of symptomatic gall bladder disease; conversion from laparoscopic to open cholecystectomy (OC) is also common.
Objective : To find out the prevalence of causes, risk factors of conversion from LC to OC among patient suffering from gall bladder disease, and to explore the most common causes of conversion from laparoscopic to open cholecystectomy.
Methods: This prospective study was conducted in the department of general surgery at Alkindy teaching hospital from first of January 2016 to the end of December 2017 .Nine hundred twenty patient were included. Patient age, gender, his
... Show MoreSocial risks posed a great challenge to the development path in Iraq, which resulted in widening the development gaps, whether these gaps were between rural and embargoed areas, or between Iraqi governorates, and the gender gap. Besides, the nature of the reciprocal relationship between the social risks and the development process requires the adoption of development trends that are sensitive to the risks that take upon themselves the prompt and correct response to these risks, away from randomness and confusion that Iraq suffered from for decades. However, currently, the situation has differed a great deal. This is because the size and types of such gaps have widened and become more complicated than before; a matter which has led to hav
... Show MoreThe Audit evedances represent the reconciliation tools between the Financial data shown on financial statements, and the level of satisfaction level of the Auditor about these statements. According that, the Auditor try to achieve the highest quantity of These evidances, and the most satisfactive of it…, but that will be so hard sometimes, when the internal controlling system is not good, and when the Auditor had some satisfied evidences, but not sharp… So, this research comes to inspect the relation between the quantity, and the level of satisfaction, and argument to prove that evidences gives. This research assumes that getting enough evidences leads to reduce faults, improves the auditing operation, and avoids risks. The research
... Show MoreThe availability of different processing levels for satellite images makes it important to measure their suitability for classification tasks. This study investigates the impact of the Landsat data processing level on the accuracy of land cover classification using a support vector machine (SVM) classifier. The classification accuracy values of Landsat 8 (LS8) and Landsat 9 (LS9) data at different processing levels vary notably. For LS9, Collection 2 Level 2 (C2L2) achieved the highest accuracy of (86.55%) with the polynomial kernel of the SVM classifier, surpassing the Fast Line-of-Sight Atmospheric Analysis of Spectral Hypercubes (FLAASH) at (85.31%) and Collection 2 Level 1 (C2L1) at (84.93%). The LS8 data exhibits similar behavior. Conv
... Show MoreBackground: Orthodontic therapy often causes external root resorption. Serum vitamin D (VD) level is important for tooth mineralization and bone remodeling. This study aimed to test the impact of vitamin D (VD) supplements on bone and root remodelling in a vitamin D (VD) deficient rat model following orthodontic retention. Methods and Material: 30 male Wistar rats were divided into three groups: a control group of 10 rats and two experimental groups of 10 rats each with vitamin D deficiency (VDD) induced by a VD-free diet for 21 days. And a third group with VD supplementAll groups received orthodontic active treatment using a modified orthodontic appliance that applied 50 gm of force for 14 days to move the maxillary right first mol
... Show MorePrenatal markers are commonly used in practice to screen for some foetal abnormalities. They can be biochemical or ultrasonic markers in addition to the newly used cell free Deoxyribonucleic Acid (DNA) estimation. This review aimed to illustrate the applications of the prenatal screening, and the reliability of these tests in detecting the presence of abnormal chromosomes such as trisomy-21, trisomy-18, and trisomy-13 in addition to neural tube defects. Prenatal markers can also be used in the anticipation of some obstetrical complications depending on levels of these markers in the mother’s circulation. In the developed countries, prenatal screening tests are regularly used during antenatal care period. Neural tube defects, numer
... Show MoreBackground: The post-operative acute abdominal complication is one of the most difficult clinical problems facing the surgeon, and it represents a unique challenge for him not only because of the difficulty in making a precise diagnosis but also in the decision for further management . Objective: discuss the post-operative acute abdominal complications requiring re-interventionType of the study: Cross sectional study. Methods : Patients with early post-operative Acute Abdominal complications ( within 30 days from the initial operation ) who required re-intervention were studied prospectively Results :The study included 82 patients 47 of them were females, their age ranging 7-87,Different types of the initial operation were reported,51 %
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