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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
Sun Apr 02 2023
Journal Name
Narst 2023 Annual International Conference
Measuring Claim-Evidence-Reasoning Using Scenario-based Assessments Grounded in Real-world Issues
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Improving students’ use of argumentation is front and center in the increasing emphasis on scientific practice in K-12 Science and STEM programs. We explore the construct validity of scenario-based assessments of claim-evidence-reasoning (CER) and the structure of the CER construct with respect to a learning progression framework. We also seek to understand how middle school students progress. Establishing the purpose of an argument is a competency that a majority of middle school students meet, whereas quantitative reasoning is the most difficult, and the Rasch model indicates that the competencies form a unidimensional hierarchy of skills. We also find no evidence of differential item functioning between different scenarios, suggesting

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Publication Date
Sun Dec 01 2013
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Obstacles in Marketing Comprehensive Automobile Insurance Policy: بحث أستطلاعي في شركة التأمين الوطنية
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Comprehensive automobile insurance is considered as an important branches in the portfolio of National Insurance Company in Iraq .Due to the continous accidents the company is endeavouring to   this market.

    The company faces several obstacles and limitations in marketing the policies of this portfolio due to certain factors and influences beyond the control of the company and others internal mainly connected with the reduction of the marketing programmes of the company .

    The target of this study is  to focus the light  upon the interal factors which can be gorerned by the company,confronted and solved.

 

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Publication Date
Wed Oct 10 2018
Journal Name
Al-kindy College Medical Journal
Recurrent Laryngeal Nerve Injury With Versus Without Nerve Identification In Different Thyroidectomy Procedures
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Background: The world health organization estimates that worldwide 2 billion people still have iodine deficiency Objectives: Is to make comparison between the effect of identification of recurrent laryngeal nerve (RLN) and non-identification of the nerve on incidence of recurrent laryngeal nerve injury (RLNI) in different thyroidectomy procedures.

Type of the study: cross –sectional study.

Methods: 132 patients with goiters underwent thyroidectomy .Identification of RLN visually by exposure were done for agroup of them and non-identification of the nerves for the other group. The outcomes of RLNI in the two groupsanalyzed statistically for the effect of

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Publication Date
Mon Feb 19 2018
Journal Name
Al-academy
Problematic employ magical realism in Arab cinema Nadine Labaki's Film (HLA Lewin) example
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Magical realism potential bulwark plastic art and literature، and won great fame and Research cash innumerable، and like other currents of literary found his outlet in the art of cinema، quoted cinema of literature magical realism and influenced his concepts، and Arab cinema، it was necessary to have a vulnerability to stream، either Tools employing magical realism، unintentionally since the early beginnings dating back to the time of World Wars I and II، or in deliberate more mature in the twenty-first century، due to the emergence of film-makers more aware and culture، and more friction global currents.


      But this raises a number of problems that need to be addressed from the maker of

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Publication Date
Wed May 10 2023
Journal Name
Journal Of Engineering
ADAPTIVE CYCLIC PREFIX LENGTH FOR CONVOLUITIONAL CODE OFDM SYSTEM IN FREQUENCY SELECTIVE CHANNEL
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Orthogonal Frequency Division Multiplexing (OFDM) is one of recent years multicarrier modulation used in order to combat the Inter Symbol Interference (ISI) introduced by frequency selective mobile radio channel. The circular extension of the data symbol, commonly referred to as cyclic prefix is one of the key elements in an OFDM transmission scheme. This paper study The influence of the cyclic prefix duration on the BER performance of an OFDM-VCPL (Orthogonal frequency division multiplexing - Variable Cyclic Prefix Length) system and the conventional OFDM system with frame 64-QAM modulation is evaluated by means of computer simulation in a multipath fading channel. The adaptation of CP is done with respect to the delay spread estimation

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Publication Date
Mon Jun 15 2020
Journal Name
Al-academy
Cloud platform functionality in visual media: علي صباح سلمان-ثائر علي جبر الله
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The rapid changes in the field of transferring and exchanging information via cloud platforms have revolutionized the field of modern visual media, as cloud computing technology has greatly influenced the media institutions, providing effort, money and high-quality materials. The research included five chapters, the first came under the methodological framework for the research and the second Theoretical framework, the first two included the concept of cloud computing and the second platforms for cloud computing in the visual media and the third chapter Research procedures and the fourth chapter The sample analysis and the fifth chapter The research results were the most prominent
1. The cloud service made the benefit beyond the typic

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Publication Date
Sat May 04 2024
Journal Name
Anais Da Academia Brasileira De Ciências
Using decapsulated local brine shrimp cysts on feeding common carp larvae in hatcheries
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The current study aims at using non-hatchable artemia eggs of local origin and making use of these eggs by decapsulating and presenting them as food for the larvae of the Cyprinus carpio as a source of animal protein with high nutritional value instead of throwing them away. The results showed that the second parameter (A2) was highly significant at the level (P≤0.05) in the growth rates of the larvae that were fed on decapsulated artemia eggs alone, and it was better than the two control parameters (A1), in which the larvae were fed with feed designated for Cyprinus carpio fish. It also outperformed the third parameter (A3), in which the feed was mixed with artemia eggs with 50% decapsulation, which also outperformed the control paramete

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Publication Date
Fri Feb 08 2019
Journal Name
Iraqi Journal Of Laser
Urinary Tract Stones Fragmentation using (2100 nm) Holmium: YAG Laser: (In vitro Analysis)
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Urinary stones are one of the most common painful disorders of the urinary system. Four new technologies have transformed the treatment of urinary stones: Electrohydraulic lithotripsy, ultrasonic lithotripsy, extracorporeal shock wave lithotripsy, and laser lithotripsy.The purpose of this study is to determine whether pulsed holmium laser energy is an effective method for fragmenting urinary tract stones in vitro, and to determine whether stone composition affects the efficacy of holmium laser lithotripsy. Human urinary stones of known composition with different sizes, shapes and colors were used for this study. The weight and the size of each stone were measured. The surgical laser system which used in our study is Ho:YAG laser(2100nm)

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Publication Date
Sat Jan 26 2019
Journal Name
Association Of Arab Universities Journal Of Engineering Sciences
Secure Mobile Sink Node location in Wireless Sensor Network using Dynamic Routing Protocol
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The important device in the Wireless Sensor Network (WSN) is the Sink Node (SN). That is used to store, collect and analyze data from every sensor node in the network. Thus the main role of SN in WSN makes it a big target for traffic analysis attack. Therefore, securing the SN position is a substantial issue. This study presents Security for Mobile Sink Node location using Dynamic Routing Protocol called (SMSNDRP), in order to increase complexity for adversary trying to discover mobile SN location. In addition to that, it minimizes network energy consumption. The proposed protocol which is applied on WSN framework consists of 50 nodes with static and mobile SN. The results havw shown in each round a dynamic change in the route to reach mobi

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Publication Date
Sat Nov 14 2020
Journal Name
Journal Of Information Systems And Telecommunication (jist)
Optical Power Distributions for 4×4 MIMO Visible Light Communications in Indoor Environment
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Visible Light Communication (VLC) has emerged as a powerful technique for wireless communication systems. Providing high data rate and increasing capacity are the major problems in VLC. Recent evidence suggests that Multiple Input Multiple Output (MIMO) technique can offers improved data rates and increased link range. This paper describes the design and implementation of visible light communication system in indoor environment exploring the benefits of MIMO. The specific objective of this research was to implement a 4× 4 Multiple Input (LEDs) Multiple Output (photodetectors)-VLC communication system, where a 16 white power LEDs in four arrays are setting up at transmitter and four RX modules are setting up at receiver side without the nee

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