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.
ABSTRACT
The multi-drug resistant efflux pump is a glycoprotein pump whose function is to push foreign substances. The efflux pump is found in humans, animals. It also has wide-ranging properties in bacteria and fungi. They are found in all species of bacteria, and efflux pump genes can be found in bacterial chromosomes or mobile genetic elements, such as plasmids. The most sensitive function that leads to a global problem is its resistance to antibiotics in bacterial cells, which increases the ability to bacteria from becoming strong virulence factors that most or all antibiotics cannot kill. It also has othe
... Show MoreDespite efforts to contain and manage the SARS-CoV-2 outbreak which was declared a public health emergency of international concern in January 2020 by the World Health Organization (WHO), the COVID-19 pandemic still remains a major global challenge. Patients who display the classical symptoms of the infection are easily identified, tested, isolated and monitored. However, many cases of infected asymptomatic patients have been documented. These patients are not easily identified even though many evidences suggest that they can spread the virus to others. How and why these COVID-19 asymptomatic presentations occur remain unclear. The many theories and views are conjectural, and supporting evidences are still needed. In this review, we
... Show MoreBackground: Immediate postpartum contraceptive and post abortion contraception methods are effective safe methods and are becoming a standard practice in many countries, yet it is not widely used in Iraq.
Aims: this study: is designed to assess the attitude and willingness of women to immediate contraception after giving birth or abortion and their satisfaction to previous use.
Methods and Material: Four hundred thirty-four women were surveyed in the labor word immediately after giving birth/ abortion. Their knowledge, attitude and contraception use were assessed according to the response they reported to a given questionnaire.
Results: women were not sure abo
... Show MoreBackground: Accurate measurement of a patient’s height and weight is an essential part of diagnosis and therapy, but there is some controversy as to how to calculate the height and weight of patients with disabilities. Objective: This study aims to use anthropometric measurements (arm span, length of leg, chest circumference, and waist circumference) to find a model (alternatives) that can allow the calculation of the height and the body weight of patients with disabilities. Additionally, a model for the prediction of weight and height measurements of patients with disabilities was established. Method: Four hander patients aged 20-80 years were enrolled in this study and divided into two groups, 210 (52.5%) male and 190 (47.5%) fe
... Show MoreLive the present companies in a competitive business environment going on and try to achieve excellence in their industry through the marketing of their products and achieve greater market share as possible to ensure its continued existence, and perhaps the concept of time production, which confirms, in essence, on the need to reduce inventory to a minimum in the production process as well as the concept of the marketing information system which asserts, in essence, to document all the events that are related to the marketing of the product provided by the production process, together constitute the subject deserves research and investigation as they have raised well-known in the fields of production management and marketing management.
... Show MoreThis paper deals with one of the most important issues in a foreign language teaching and learning, i.e. speaking test assessment. After giving a survey of literature written on the meaning and definition of a speaking test assessment, two sections have been devoted to tackle the most important issues in this topic. Section one, which is the theoretical part of this paper, sheds light on the basic definitions of the term ‘speaking assessment’ which are, according to the researcher’s point of view, sufficient to cover the area of the study. This section based on applied linguistic theories and researches in order to enhance our understanding of the what is meant by «a speaking test assessment«In addition,it explains the most importan
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The decision maker needs to understand the strategic environment to be addressed through different means and methods. It is obvious that there is a difference between the three strategic environments (conflict environment, peace environment, post- peace environment) in terms of inputs and strategies to deal with each one of them. There is an urgent need to understand each pattern separately, analyze its inputs, and identify the factors and variables that affect the continuity of this situation (conflict, peace, post-peace). It is not appropriate to identify treatment without diagnosis of the condition, so it is very important to understand the type of strategic environment to be dealt with it.
... Show MoreChitinase-3-like 1 protein (YKL-40) is a glycoprotein primarily produced in the arthritic joint and plays a crucial role in inflammatory processes. The aim of the study is to establish the role of YKL-40 as a biomarker for rheumatoid arthritis (RA) compared to proinflammatory biomarkers and disease activity. The study included 58 patients and 18 control. Diseases activity score (DAS-28) and clinical disease activity index (CDAI) were measured. Serum level of YKL-40, tumor necrosis factor-α (TNF-α), interleukin-1B (IL-1β), erythrocyte sedimentation (ESR), rheumatoid factor (RF), C-reactive protein (CRP), and anti-citrullinated protein antibody (ACPA) were assessed. The results showed that the median serum YKL-40 level which was 5.42
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The open budget means everyone in the society can get information about the government budget in order to watch the governmental works. The aim of the research is to study the concepts of open budget, its advantage, limitations, role of supporting the transparency and questioning the administrative and financial corruption. Thus reflects positively on the national economy by providing governmental information to all users whether they are individuals or belong to the political class, or any other governmental or nongovernmental organizations which are interested in these information.
In order to achieve the objectives of the research aims, we make questionnaire to see aca
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