Background: Ruptured posterior communicating artery (PCoA) aneurysms are common; they usually present with subarachnoid haemorrhage (SAH) and oculomotor nerve palsy. The aneurysmal dome projection may influence the safety access and aneurysmal neck clipping. Here, we discuss additional intraoperative steps that may be required to widen the surgical field to ensure safe surgical clipping of a rupture pure posteriorly directed PCoA aneurysm. Case description: A previously healthy 38-year-old male reported sudden severe headache and disturbed level of consciousness with a Glasgow coma scale (GCS) of 13. His initial computed tomography (CT) scan of the head showed SAH in the basal cistern. 3D-constructed CT angiography (CTA) revealed a left pure posteriorly directed PCoA aneurysm. In the surgery, through the left pterional approach, all intraoperative steps were carried out. Additional steps were performed as well. Three additional intraoperative steps were contemplated because a pure posteriorly directed PCoA aneurysm is not well appreciated and is often hidden behind the supra cliniold internal carotid artery (ICA). First, the extension of Sylvian fissure dissection to include the distal part and the proximal. Second, temporal pole mobilization is performed by cutting small anterior temporal veins. Third, a brain retractor is placed on the temporal lobe to gently tract the superficial part of the lobe. All these steps widened the surgical corridor to ensure the aneurysm's safe clipping. Conclusion: Surgical clipping is influenced by the aneurysmal dome projection. In a ruptured pure posteriorly directed PCoA aneurysm, further intraoperative steps may facilitate complete access and safe clipping of the aneurysm.
Background: Study looking into cardiovascular disorders (CVD) medicines or analgesics cost-saving activities during dispensing process is lacking.
Aim: To determine differences in factors and costs associated with refused CVD medicines or analgesics during dispensing process
Method: This study was approved by Medical Research and Ethics Committee (MREC) (Registration number: NMRR-20-177-53153(IIR)). Participants receiving CVD medicines or analgesics during dispensing process were recruited via convenience sampling technique between February and March 2020 at the Specialist Pharmacy Department of Jerantut Hospital, Malaysia. Refusal to medications and its reasons were asked based on the questionnaire developed by the resea
... Show MoreThe aim of the current study was to develop a nanostructured double-layer for hydrophobic molecules delivery system. The developed double-layer consisted of polyethylene glycol-based polymeric (PEG) followed by gelatin sub coating of the core hydrophobic molecules containing sodium citrate. The polymeric composition ratio of PEG and the amount of the sub coating gelatin were optimized using the two-level fractional method. The nanoparticles were characterized using AFM and FT-IR techniques. The size of these nano capsules was in the range of 39-76 nm depending on drug loading concentration. The drug was effectively loaded into PEG-Gelatin nanoparticles (≈47%). The hydrophobic molecules-release characteristics in terms of controlled-releas
... Show MoreThe support qualitative information regards as an additional step in the process of decision-making where the method following by companies to provide information help in the creation of value because it is very important to deliver information to investors about their stratigies and what happen truly inside the companies i.e. every case relating with the expectations of stockhotslder and the prices of markets depending on those expectation ,and if the matter isn’t that there will be lack of confidence thate couldn’t be backed again. The decisions of the investors effected by security ,economic ,political, psychological, emotional ,and financial factors .
... Show MoreThe study aimed at identifying the strategic gaps in the actual reality of the management of public organizations investigated to determine the strategy used based on the study model. The study relied on the variable of the general organization strategy in its dimensions (the general organization strategy, the organization's political strategy and the defense strategy of the organization) The sample of the study was (General Directorate of Traffic, Civil Status Directorate and Civil Defense Directorate), formations affiliated to the Ministry of the Interior, for the importance of the activity carried out by these public organizations by providing them In order to translate the answers into a quantitative expression in the analysi
... Show MoreThe research aims at shedding light on the impact of the organizational commitment on the performance of the Iraqi insurance company as a service company that provides many services to customers both internal (individuals working) or external, Whenever the company was able to adopt new concepts to increase the understanding and knowledge of how their attention to individuals working and to provide an appropriate working environment, and to clarify the objectives and strategies for them, and create a sense of their importance, as reflected on job performance in attracting new customers, and build long-term relationships with them . In order to achieve this, the research relied on the questionnaire as a main tool for collecting data and in
... Show MoreThe deficit budget, one of the results of increased public spending for their revenues due to the economic pressures imposed by the interest of the economies of those countries from the need to increase government spending in order to revitalize the national economy and accelerate economic growth rates and provide employment to the growing levels of unemployment in those countries opportunities and what is required to address the current debt crisis (borrowing), which has become a big burden on the governments and the need to move towards the application of austerity spending and tax increases, which inevitably forced those countries will be reflected reduced spending on basic aspects of life and their peoples, particularly earners
... Show MoreAny city that has such a market and is organized, organized and established
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في هذا العصر - الذي داهمت في الأخطار لغة الفصاحة والبيان - يبقى القرآن الكريم أعظم حافظ للغة السليمة ، وأكبر معين لأهلها للحفاظ على ثرائها وبلاغتها ، فهي باقية ببقائه ما بقي الليل والنهار .
وهذا البحث يدور حول حفظ القرآن الكريم وأثره على لغة الطفل، ويتكون من مقدمة : وفيها بيان أهمية الموضوع ، وخطة البحث ، ومنهجه، وثلاثة مباحث:
المبحث الأول : فضل حفظ القرآن الكريم ، وفوائد حفظه إجمالاً ، والمبحث الثاني :
... Show MoreWitnessing the global arena many changes in the political, economic, social, scientific and technological have left their mark on the world as a whole, these changes require necessarily Advancement of the profession of auditing, and improve their performance, especially after the mixer skepticism the health of approach and the method followed by a check in the major audit firms global view as for the external audit of an active role in providing services to members of the community in various sectors, were to be provide these services to the highest level of quality.To ensure the quality of the audit process to be a proper planning is based on a scientific basis to be the substrate a strong underlying different audit works, and if planni
... Show MoreIn this paper, a literature survey was introduced to study of enhancing the hazy images , because most of the images captured in outdoor images have low contrast, color distortion, and limited visual because the weather conditions such as haze and that leads to decrease the quality of images capture. This study is of great importance in many applications such as surveillance, detection, remote sensing, aerial image, recognition, radar, etc. The published researches on haze removal are divided into several divisions, some of which depend on enhancement the image, some of which depend on the physical model of deformation, and some of them depend on the number of images used and are divided into single-image and multiple images dehazing model
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